Hard time with BP in rig

T

tnoye1337

Forum Crew Member
Messages
81
Reaction score
2
Points
0
Well I went on a call the other day and it was my first time teching along with the first time doing vitals without a life pack in the ambulance. I was feeling for a pulse and simple could not find it through all the bumps in the road. Along with that I couldn't get an accurate BP because I simply couldn't hear anything. The EMT that I was with said it would get better with time, but I feel like it won't.
 
Take your vitals before you leave?

Practice.

Practice.

Practice.

Sometimes if you have too nice of a scope you hear too much background noise.

The pulse, I don't know what to tell you. Are you sure they had a radial? They'd be pretty sick if they didn't though...I've never had a problem finding a radial pulse in the ambulance, moving or not.
 
Well that's why I didn't mention about vitals prior to getting into the rig. That's the easy part. Trust me the scope wasn't too nice. The other EMT on board was able to get her pulse. I guess it's something I have to work on.
 
I've had trouble getting a bp before but not a pulse. Practice is exactly what is needed.
 
It could just be her age I guess. I'll make sure I practice every opportunity I get.
 
tnoye1337 said:
It could just be her age I guess. I'll make sure I practice every opportunity I get.
Click to expand...

I doubt it unless she was morbidly obese.

Age doesn't make a BP easier or more difficult to hear.
 
Try palpating the brachial pulse before you put your scope down.

And try to not put the edge of you scope under the cuff, it may interfere with your ability to hear an accurate pressure as it will also put pressure over your pulse points. Seen a few new folks do this recently.

That and, Practice, practice, practice. It will come easier with time.

You’re a professional now, bite the bullet and get you a good stethoscope. Whatever you hear best with, don’t just get the name brand everyone else has. Get one that works for you.
 
Practice is what will make this better, but you need to practice in the right environment. You will not get better at taking vitals in a moving ambulance if your practice in your living room. Be the one that takes vitals on every call. Eventually your ears will be conditioned to the sounds that they're looking for. As for pulses, try both hands and don't be afraid to firmly grasp their arms.
 
tnoye1337 said:
Along with that I couldn't get an accurate BP because I simply couldn't hear anything.
Click to expand...
I also can never hear anything. I recommend practice.
 
NVRob said:
I doubt it unless she was morbidly obese.

Age doesn't make a BP easier or more difficult to hear.
Click to expand...

In that context I was talking about her pulse. Sorry if I wasn't specific.
 
It will get better! It'll take time ands practice. I remember it feeling the same way when I started but it does get better :) if you can't get a radial auscultate or palpate the carotid just be gentle
 
If the ambulance is in motion, ask your driver to let off the gas while you're getting the BP. I do this automatically if I see my partner trying to get a BP while we're moving.

If you're running without lights/siren, get one at a stoplight.

If you're running with lights/siren, you're not going to hear it. Palpate.
 
At least you have an encouraging partner...I lost a job recently because of my skills not growing to mastery within a month pretty much....dumb partner.

Anyways here's what to do. practice locating your own brachial pulse in your arm then you'll know exactly where to put the stethescope.

then what you also do is you put the stethescope UNDERNEATH the blood pressure cuff while it inflates...making it quieter and easier to hear.

Also keep your feet off the floor when you do it because the sound moving up through your legs creates extra noise.

I've acquired a few BP's on the road thanks to these measures. Sometimes its just a hard to hear though if its a hard to hear pulse area.
 
Just some tips:

From the bench seat, put your feet on the bottom of the gurney, place the pt's arm on your knee, if you can try to hear a pulse prior to inflating the cuff, while you're deflating the cuff prevent the various tubes from banging together and if at any point you're unsure of whether you hear the pulse or just the ambo bouning around, just close the valve and reinflate a little bit.

And if you sincerely can't get it, palp. It's better than nothing.
 
Best is to try to isolate the extremity from the cot. Prop their arm up on your knee, and try to get your foot as high off the floor of the truck as you can. I go up on tiptoe on the leg that their arm is resting on. Just keeps all the road noise from coming up through your leg and jacking with your reading.

Also, if it's a continuing problem, maybe check out buying your own BP cuff that is just one tube with the gauge fixed on the bulb, and keep that with you whenever you're working. I know sometimes the tubes bouncing around and rubbing against each other chand the head of the stethoscope could be a problem.

I've used ones like this before. They're pretty nice.

50-0050-2T.jpg
 
The simple approach is to go 20mmHg higher than your initial BP from in the house (or before wheels were rolling) and listen from there down.

If that fails, go to a palp pressure and then go 20-30mmHg above that, and listen from there down.

If that fails, you at least have a by-palp pressure.

If that fails, go to pulse quality. While a positive radial pulse likely means a BP >80mmHg, it doesn't necessarily mean that; I've had septic shock patients with radials and BP's <80mmHg.

Correlate their palpable pulses with their mental status: answering questions appropriately and without hesitation? Joking with you? Those are higher level mental functions which require adequate perfusion. Their cerebral perfusion pressure is most likely greater than 70mmHg!

If their CPP is >70mmHg, this means their mean arterial pressure (MAP) is greater than 60mmHg!

If you don't have a systolic and diastolic pressure to use, think of MAP as: (CO x SVR) + CVP

CO = Cardiac Output
SVR = Systemic vascular resistance
CVP = Central venous pressure

So with radial pulses and good mentation we know that the patient is maintaining the appropriate level of Cardiac Output, Vessel Tone (SVR), and Blood return (CVP) in order to perfuse their brain!

Not being able to auscultate a blood pressure is going to happen on occasion, so give yourself credit for the appropriate level of examination. Document the secondary findings of an adequate blood pressure and you'll be fine.
 
I bring it up to 220ish *higher is Hx of htn or got a high reading inside* and watch the needle as you drop it down listen for the sound as the needle moves, it helps you discern from the rest of the bumps/sirens/noises. If you're desperate, you can use the bell of the scope - but the bp sounds more like a whoosh than a thump. Best advice I can give is to go buy a decent littman scope and practice - keep the arm fully exstended and palp if you can, if you can't use your best guess - the littman scopes do a great job of picking it up even if your not right on the artery.
 
also, on fleshy patients you can place the cuff on the forearm and listen at the radius.
 
You must log in or register to reply here.
Back
Top