I went through EMT Basic in January and have finished all but the NREMT exam for Paramedic certification and I still have a little trouble getting an accurate BP while enroute to the hospital on occasions. Sometimes it is easy to hear but other times I simply have no way of getting an accurate reading... which can be a critical part of my assessment of my patient... are there any tricks you know of to help me out a little bit since I am rather new at this? Thanks!
Does anyone have trouble getting accurate BPs in the back of the ambulance?
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katgrl2003
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You will probably get tired of hearing this. Practice, practice, practice.
I work with a medic, and I was having the same issue about a week ago on a long distance run. I told him to pull over. If you have the time, and the patient condition allows it, take the pressure before you start transporting. That way, you will have a good baseline for the next one you take.
-Kat
I work with a medic, and I was having the same issue about a week ago on a long distance run. I told him to pull over. If you have the time, and the patient condition allows it, take the pressure before you start transporting. That way, you will have a good baseline for the next one you take.
-Kat
enjoynz
Lady Enjoynz
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THe EMT-I's I crew with, always use the lazy person's BP, NIBP off the Defib.:blink:
But pulling over and taking it on route is the other best option I've found.
It's a 1/2 hour drive for us to transport to hospital, so we have set places on route to pull over and take vitals. Of course this depends on how sick your pt is as well:excl:
Cheers Enjoynz
But pulling over and taking it on route is the other best option I've found.
It's a 1/2 hour drive for us to transport to hospital, so we have set places on route to pull over and take vitals. Of course this depends on how sick your pt is as well:excl:
Cheers Enjoynz
katgrl2003
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Ok, I gotta admit, I use the lazy person's BP too. But if I start getting some really wonky numbers, I'll take it the regular way.
-Kat
-Kat
BossyCow
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This is a basic skill and there is no excuse for not developing it well. Practice, practice and practice. I think a lot of new EMT's use palp as a way of avoiding doing an accurate BP under difficult conditions.
Keep your feet stable, make sure the pt's arm isn't thumping against the stretcher frame, make sure your scope is firmly in your ears and adjusted so you can hear properly. Place the bell firmly against the artery and listen carefully.
There are a lot of more detailed threads here about doing good B/P's and "Just find a lazy shortcut" is never, ever good advice. If you want to be a good EMT than learn how to do the skills well. Nobody ever starts out knowing everything, and you will get there if you want to improve.
Keep your feet stable, make sure the pt's arm isn't thumping against the stretcher frame, make sure your scope is firmly in your ears and adjusted so you can hear properly. Place the bell firmly against the artery and listen carefully.
There are a lot of more detailed threads here about doing good B/P's and "Just find a lazy shortcut" is never, ever good advice. If you want to be a good EMT than learn how to do the skills well. Nobody ever starts out knowing everything, and you will get there if you want to improve.
I do this and it is still difficult
katgrl2003
Forum Asst. Chief
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Make sure you are over the artery. Try palpating the artery and placing the bell directly over it. On the practice side, grab your partner and take his/her bp. A few months ago, we had a new EMT with the same issues and he ended up taking the bp's of everybody on shift.
-Kat
-Kat
ErinCooley
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Do you have a good stethescope? I was having lots of trouble until I bought a good one.. I havent have any problems since!!
medic001918
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Definitely practice. A pressure by palp is not acceptable to me in most cases. If I ask for a blood pressure, it means I want a blood pressure. Not a short cut. As far as using the NIBP, my partners are not allowed to use it to obtain a blood pressure. I don't use it myself most of the time, and when I do it's only after obtaining a manual blood pressure. As far as pulling over to obtain a blood pressure, that's not something I'm really into either. It's great if you have a stable patient, but those stable patients are great practice to learn to take one in the back of a moving ambulance. That way when the patient is not stable, you're capable of doing the job that's expected of you.
Like other's said, make sure your scope is over the artery and that you're pressing hard enough to maintain a good seal from outside noise. Try to eliminate excess movement. And practice over and over again.
Shane
NREMT-P
Like other's said, make sure your scope is over the artery and that you're pressing hard enough to maintain a good seal from outside noise. Try to eliminate excess movement. And practice over and over again.
Shane
NREMT-P
Meursault
Organic Mechanic
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With a bit of practice (I'm fairly new, but I've learned to do it), you can get accurate BPs without possibly inaccurate shortcuts.
The tips in here are good, and there are more tips, more detailed discussion, and some fun flamefests about the need for accurate, rapid blood pressures by auscultation buried in the forums.
Something I've found useful is to brace my foot against the bottom rails on the cot and rest the patient's arm on my knee. If the road's especially bumpy, that's not going to work, but it usually helps steady their arm and get good scope contact.
Having a Littmann Master Cardio also helps, you lucky :censored:.
The tips in here are good, and there are more tips, more detailed discussion, and some fun flamefests about the need for accurate, rapid blood pressures by auscultation buried in the forums.
Something I've found useful is to brace my foot against the bottom rails on the cot and rest the patient's arm on my knee. If the road's especially bumpy, that's not going to work, but it usually helps steady their arm and get good scope contact.
Having a Littmann Master Cardio also helps, you lucky :censored:.
Ridryder911
EMS Guru
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Palpation = guessamation... basically means nothing.
Like others stated.. practice, practice, practice. If you still cannot get it, have someone demonstrate over and over. It is a BASIC skill.
Using an automatic blood pressure is not accurate in the field, if one does not obtain a base line value first, before using an automatic B/P cuff. Movement, road vibration, can give inaccuracy or false reading. Each number is improtant! Hence the reason is part of a VITAL sign!
If all else fails, get hearing checked.. (no joke) many can hear low tones...
R/r 911
Like others stated.. practice, practice, practice. If you still cannot get it, have someone demonstrate over and over. It is a BASIC skill.
Using an automatic blood pressure is not accurate in the field, if one does not obtain a base line value first, before using an automatic B/P cuff. Movement, road vibration, can give inaccuracy or false reading. Each number is improtant! Hence the reason is part of a VITAL sign!
If all else fails, get hearing checked.. (no joke) many can hear low tones...
R/r 911
yay4stress
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hold on now, what's with this bashing of BP by palp?
I agree that a BP should be taken by auscultation before leaving the scene, but if you have that, then a BP by palp en route is not going to be a huge problem. Plus, if your pt is still talking to you and they're not bleeding profusely, there's a good chance that the diastolic BP isn't quite as important as the systolic, and if they're not talking to you, or they are bleeding profusely, if your not on a BLS truck then I'm guessing you have them on the monitor already.
not to be argumentative or anything, and I definitely agree that auscultation is better (more accurate, more useful), and that practice is by far the best solution to any problem like this, but BP by palp is definitely useful if your having trouble hearing.
okay, all done.
I agree that a BP should be taken by auscultation before leaving the scene, but if you have that, then a BP by palp en route is not going to be a huge problem. Plus, if your pt is still talking to you and they're not bleeding profusely, there's a good chance that the diastolic BP isn't quite as important as the systolic, and if they're not talking to you, or they are bleeding profusely, if your not on a BLS truck then I'm guessing you have them on the monitor already.
not to be argumentative or anything, and I definitely agree that auscultation is better (more accurate, more useful), and that practice is by far the best solution to any problem like this, but BP by palp is definitely useful if your having trouble hearing.
okay, all done.
Ridryder911
EMS Guru
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Okay, how accurate is that palpated blood pressure? Can you explain pulse pressure and alternans that can commonly effect palpated pressures. As well, how much pressure is needed to get a radial/brachial pulse?
Please do not refer to the old myth radial pulse = 70-90 systolic, etc.. It has never been proven scientifically to ever guess-a-mate by pulse points pressure, and has been removed from the ATLS instruction.
If you want a "ball-park" pressure, sure palpated, or better yet use a doppler. (Yes, we carry one on every truck)
The only time a palpated pressure should be obtained is because it is impossible to hear or auscultate a blood pressure due pt.'s poor perfusion level or temporary extreme ambient noise. Most of the time they are performed because of laziness.
R/r 911
Please do not refer to the old myth radial pulse = 70-90 systolic, etc.. It has never been proven scientifically to ever guess-a-mate by pulse points pressure, and has been removed from the ATLS instruction.
If you want a "ball-park" pressure, sure palpated, or better yet use a doppler. (Yes, we carry one on every truck)
The only time a palpated pressure should be obtained is because it is impossible to hear or auscultate a blood pressure due pt.'s poor perfusion level or temporary extreme ambient noise. Most of the time they are performed because of laziness.
R/r 911
I've had good luck with this method as well!
yay4stress
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I agree whole heartedly, I refer only to those situations when an estimation is all you need. At my service, we use palpation frequently with BLS patients when calling the vitals in to the receiving facility and a full set of vitals is just not viable with the timing.
Our service requires us to get at least two sets of vitals for every call, so if we have a 4 minute transport (which does happen sometimes), BP/palp becomes a great option due to the fact that most of our transports are on the highway and it's a lot quicker. Palpation fulfills our charting requirements and, like it or not, does give the hospital a decent idea (key word, idea) of the progressions of the patient's condition.
That being said, I want to be clear that when I say "bp by palp", I don't mean "pt has a radial pulse, therefore his bp is 90/palp". I mean, putting on a bp cuff, increasing pressure until a radial pulse is no longer present, and then releasing presssure until the radial pulse shows up. I think it goes without saying that this method isn't always the best idea, but palp is often viable, at least for our service.
Our service requires us to get at least two sets of vitals for every call, so if we have a 4 minute transport (which does happen sometimes), BP/palp becomes a great option due to the fact that most of our transports are on the highway and it's a lot quicker. Palpation fulfills our charting requirements and, like it or not, does give the hospital a decent idea (key word, idea) of the progressions of the patient's condition.
That being said, I want to be clear that when I say "bp by palp", I don't mean "pt has a radial pulse, therefore his bp is 90/palp". I mean, putting on a bp cuff, increasing pressure until a radial pulse is no longer present, and then releasing presssure until the radial pulse shows up. I think it goes without saying that this method isn't always the best idea, but palp is often viable, at least for our service.
Ridryder911
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So basically you are guessing at the vitals? Sorry, there is no point of reporting estimated vital signs. Why? They are worthless, and as well presents that you are unable to perform your job. It appears you are only placing numbers for charting purposes. Remember, you will held be accountable if there is problems later on. If the patient suddenly deteriorates and your vital signs reflects differently or questioned why an accurate set was not taken, (as set out by the national curriculum) are you going to say .."It was easier"....
Taking a B/P takes <30 seconds, even those that are hard to hear. If one is proficient in their skills, then one does not have to take short cuts. Remember taking short cuts only leads to long term problems.
Again, the only reason palpation is even taught is for the patients with such poor perfusion and ambient noises it be impossible to auscultate. I am not against palpated blood pressures, but when one gives me a palpated B/P it should mean other methods has been attempted prior, like doppler B/P.
R/r 911
Taking a B/P takes <30 seconds, even those that are hard to hear. If one is proficient in their skills, then one does not have to take short cuts. Remember taking short cuts only leads to long term problems.
Again, the only reason palpation is even taught is for the patients with such poor perfusion and ambient noises it be impossible to auscultate. I am not against palpated blood pressures, but when one gives me a palpated B/P it should mean other methods has been attempted prior, like doppler B/P.
R/r 911