For the love of God...

EMTBell said:
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Of course the stethoscope is primarily diagnostic, and not as important at my level as say an ALS provider. For instance, what if a medic lost their stethoscope and didnt notice rales indicating pulmonary edema, but still infused 1000 ml NS? Entirely hypothetical of course
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Fair enough. That medical director would get me pushing back at him just as hard though.

That medic shouldn't be infusing fluids without assessing lung sounds so fail on the medic's part. :P
 
Definitely an important skill! Agree with Mountain Res-Q on how it should only be used in certain situations, not as the norm.
edit: haha yeah I guess I don't know much about paramedic protocol anyways
 
Mountain Res-Q said:
11 Years of Ambulance, First Response, and SAR, and I can say that I have only been forced to take a BP by palpation a handful of times (inside the helo, windstorm, etc.). What irritates me is when palpation is the habit and not the exception used only when you have no other choice. "Acceptable" only under certain circumstances; not the equivalent!
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I fully support that SBP/palp should not be done regularly.

I have taken SBPs of 50-60 over palp in both field and hospital environments. I simply couldn't get the diastolic.
 
Remeber343 said:
50-60 sbp shouldn't be felt at a radial...?
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search back a few months, look for medic robs post in the advanced medical discussions.
 
Veneficus said:
I fully support that SBP/palp should not be done regularly.

I have taken SBPs of 50-60 over palp in both field and hospital environments. I simply couldn't get the diastolic.
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Time and place for everything. It is a tool; like using a butter knife when a screw driver is not around... it works, but is not optimal. It, to me, is a symptom of a problem when it becomes the standard (easy way out) for people that need to move on.


NVRob said:
That myth has been defeated.
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And yet, it still pops up as truth. Disturbing that so many myths like that, "backboarding prevents spinal injury", and "everyone gets O2" are still SOP for people. <sigh>

Its been a long day...
 
Remeber343 said:
50-60 sbp shouldn't be felt at a radial...?
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Hmmm, I have had a few patients that need to go back and re-read the textbook then.

Oh wait, it isn't in any textbooks because it was based on anecdote and not actual science. When actual science tested it out (albeit with a small pt population) they found it was mostly BS.
 
Mountain Res-Q said:
And yet, it still pops up as truth. Disturbing that so many myths like that, "backboarding prevents spinal injury", and "everyone gets O2" are still SOP for people. <sigh>

Its been a long day...
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I'm starting to think beating people with NRBs while they are strapped to a backboard is a good idea.
 
Aidey said:
I'm starting to think beating people with NRBs while they are strapped to a backboard is a good idea.
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Some people deserve it. Others dish out good money to call girls for it. I prefer room air, no bondage, and a good episode of MYTH BUSTERS.
 
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Aidey said:
I'm starting to think beating people with NRBs while they are strapped to a backboard is a good idea.
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I like this idea.
 
Aidey, that's negligent.... you forgot to say you'd administer nalaxone too!

I think that podcast medicRob used had a very small sample size (wasn't it 18 ICU patients?). I personally wouldn't use it to say that estimating the systolic blood pressure (SBP) by palpation is debunked, but rather try to convince others that more research needs to be done on it if we are going to pick numbers or ranges to estimate the SBP by palpation, if more criterias should be used to get a more accurate number or range, if the numbers that are currently taught are accurate (e.g. age, height, length of arm), or if there is so much anatomical variations that we can't select numbers or ranges to estimate the SBP.
 
Aprz said:
Aidey, that's negligent.... you forgot to say you'd administer nalaxone too!

I think that podcast medicRob used had a very small sample size (wasn't it 18 ICU patients?). I personally wouldn't use it to say that estimating the systolic blood pressure (SBP) by palpation is debunked, but rather try to convince others that more research needs to be done on it if we are going to pick numbers or ranges to estimate the SBP by palpation, if more criterias should be used to get a more accurate number or range, if the numbers that are currently taught are accurate (e.g. age, height, length of arm), or if there is so much anatomical variations that we can't select numbers or ranges to estimate the SBP.
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There is too much to it to estimate ranges. Age, length,sex, cardiac output, various disease pathologies, general health status, medications, the list of things that affect it goes on and on.

Furthermore, SBP is a really poor indicator for perfusion status.

The idea behind using it had the flaw of assuming both adequete volume and a closed circuit.

Pulse pressure is more useful indicator, not as good as MAP, which is not as good as CVP. (rather impractical in EMS)

If you are going for a quick measure of perfusion status, I think you will find that qualitative physical findings work just as well if not better than quantitative BP measurements in the EMS environment.
 
Aprz said:
Aidey, that's negligent.... you forgot to say you'd administer nalaxone too!

I think that podcast medicRob used had a very small sample size (wasn't it 18 ICU patients?). I personally wouldn't use it to say that estimating the systolic blood pressure (SBP) by palpation is debunked, but rather try to convince others that more research needs to be done on it if we are going to pick numbers or ranges to estimate the SBP by palpation, if more criterias should be used to get a more accurate number or range, if the numbers that are currently taught are accurate (e.g. age, height, length of arm), or if there is so much anatomical variations that we can't select numbers or ranges to estimate the SBP.
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Like backboards, and trendelenburgs what evidence was there in the first place that estimating BP by pulse location was accurate? I suspect there is very little evidence supporting it. For some reason though it always takes 100 times the evidence to debunk something that it did proving it.
 
Whoops, you guys are definitely right. I didn't think about the evidence before they started teaching this method of estimating.

I'm still gonna tell everyone you forgot to administer naloxone.
 
There's a couple of case series out there that basically debunk estimation of blood pressure by palpation.

Deakin & Low report 10/12 hypotensive trauma patients with an art line and a radial pulse had SBP < 80 mmHg, including one with a SBP of 52 mmHg.

In patients with no radial, but present femoral and carotids, 10/12 were <70mmHg.




http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27481/?tool=pubmed


Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ. 2000 Sep 16;321(7262):673-4.

Poulton TJ.ATLS paradigm fails.Ann Emerg Med. 1988 Jan;17(1):107.
 
Lotsa old thread revivals today.

I don't think anyone would tell you to go to medical school to learn what NRB stands for. A good search would've been ems nrb, emt nrb, etc. Anyway, its Non-ReBreather mask, as opposed to a simple mask. The idea for the NRB is that you won't inhale what you just exhaled (for the most part).
 
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