Hard time with BP in rig

[KyleG]

Couple tricks I use is one use stop lights and stop times to find a pulse and get your bearings. For the BP press hard on your scope to clear out a lot of sounds.

 

[tnoye1337]

Thanks for all the tips guys and gals. I'll try them out on my next call if I ever get one -_-

 

[SoCal911]

Clinicals?

 

[Akulahawk]

First off, don't stress. Getting stressed out about not hearing/feeling the appropriate stuff in the back of the ambulance won't help you. It also stresses your patient out. You look stressed, then they're going to wonder what's wrong and they'll start on ya...

The biggest thing to do is to try to isolate the patient's arm from all background noise/sources of noise. That means you pick the arm up and "float" it off the gurney. For the radial pulse, support the weight of the wrist with your thumb and 4th and 5th fingers. Your index and middle finger pads are then free to place as much or as little pressure as needed to feel even a weak/thready pulse. If I remember, I'll take a picture of me doing this with a classmate in a couple days. Sometimes it just takes a picture...

For BP, cradle their arm in yours or put your toes on gurney and get those heels off the floor. Lay the arm across your knee and palpate for the brachial pulse. Once it's located, inflate the cuff as you palpate the pulse. Once it goes away, inflate a bit more and put your steth head on that spot. Then deflate the cuff slowly while you LISTEN to the road noise. You'll start hearing the Korotkoff sounds come up out of the background noise and there's your SBP... It's all the same, just with more background noise than you're used to.

There have been very few times that I've been unable to get a manual BP in the back of the ambulance, even when running Code 3 using the above technique. I've had more trouble getting an autocuff to take a BP accurately than me hearing one in less time...

This is a skill and once learned, it's a little like riding a bike - you don't forget but you can get rusty at it. I've probably done between 20k and 30k BP measurements to date...in the back of moving ambulances. After you've done a couple hundred, it's not so difficult to do. It just takes practice. You'll improve with time and practice and soon you'll wonder why that new guy is having such a hard time with getting vitals in the back of your ambulance. Really.

 

[tnoye1337]

Clinicals?

My problem isn't getting a blood pressure on solid ground. It's the fact that all of the background noise is making it very hard to hear the sounds. I wouldn't have passed my EMT skills test if I didn't know how to take a BP

 

[docmoods]

Quickly obtain a baseline BP prior to loading your pt. then if you cant hear a manual BP while enroute try obtaining a palpated BP this also takes practice but it will give you a ball-park estimate of where the pressure is. (Palpated BP refers to feeling for a radial pulse and follow the radial pulse while utilizing your cuff, when you feel a pulse after deflating the cuff there's your systolic BP, you can not get a diastolic pressure accurately this way however).

-Moods

 

[tnoye1337]

Quickly obtain a baseline BP prior to loading your pt. then if you cant hear a manual BP while enroute try obtaining a palpated BP this also takes practice but it will give you a ball-park estimate of where the pressure is. (Palpated BP refers to feeling for a radial pulse and follow the radial pulse while utilizing your cuff, when you feel a pulse after deflating the cuff there's your systolic BP, you can not get a diastolic pressure accurately this way however).

-Moods

Yeah I know how to do BP by palp. They taught it to us briefly in my EMT class, but I won't be able to do that, until I can feel a damn radial pulse in the rig. Sooooo bumpyyyyy

 

[Brandon O]

That means you pick the arm up and "float" it off the gurney. For the radial pulse, support the weight of the wrist with your thumb and 4th and 5th fingers. Your index and middle finger pads are then free to place as much or as little pressure as needed to feel even a weak/thready pulse. If I remember, I'll take a picture of me doing this with a classmate in a couple days. Sometimes it just takes a picture...

 

[Tigger]

Yeah I know how to do BP by palp. They taught it to us briefly in my EMT class, but I won't be able to do that, until I can feel a damn radial pulse in the rig. Sooooo bumpyyyyy

If you keep saying you're not going to find it, you're not going to. Don't make excuses, go practice. There is rarely an excuse for not being able to obtain a pulse in the truck, it is not a difficult skill if you practice.

 

[ExpatMedic0]

in the rig sometimes you have to get a b/p by palpation. Keep practicing feeling for radial pulses in your spare time. You might find your own little nack/ sweet spot. Its a lot easier to acquire one by palp than auscultation in a moving ambulance. Do not make a lazy habit out of doing B/P's by palp on every occasion. Sometimes palp the way to go, especially in the rig or when its very difficult to auscultate. Also remember to get proper baseline vitals before transport.

PS: as the other guy said, make sure you buy yourself a nice stethoscope. Your own personal one, like a littmann or something.

 

[Tigger]

I'm not trying to sound all high and mighty, but I think I've taken maybe 5 BPs by palp ever, and those were special situations like bariatrics or not being able to remove clothing during a dialysis trip. If you never have to "resort" to palp, you're ears will have a lot easier time learning to hear the right noises.

 

[Akulahawk]

There have been times that I've had to "resort" to taking a palpated BP. Although I'm good at it, I never preferred it. Those times have always been when I can not hear the sounds because it's too loud, bumpy, or the patient's too large and a lot of sub-q fat just buries the artery. I've probably had to do it maybe on 50 patients out of probably 4-5 thousand...