Manual BP

Thing is I dont do the triage due to I'm not an RN. However if they are assesed for SOB,CP,or any what is deamed emergent we hook them up. If they are just there to try and get an old script filled they see the PA and are put in what we call the "fast track" area.
 
Taking a manual B/P is a vital skill. The biggest help? A good stethoscope. I'm not sure you can beat the Maxiscope for the price.

Two word phrase EMS needs to learn with regards to technology. "Correlate clinically". I had a patient with a automated pressure of 68/46 yesterday. I didn't go tearing off to get a manual because it fit the clinical picture. Look at the patient and the value. If they don't go together, figure out why, don't just discard the B/P. Your assumptions about the PATIENT may be wrong, which can be life threatening.
 
usalsfyre said:
The problem with the policy is that I would wager "every second counts" in less than 0.1% of a percent of cases.
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And in those cases an accurate set of vitals are pretty important.

Thats barring arrest, though.

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guttruck said:
Thing is I dont do the triage due to I'm not an RN. However if they are assesed for SOB,CP,or any what is deamed emergent we hook them up. If they are just there to try and get an old script filled they see the PA and are put in what we call the "fast track" area.
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I see your point, in my area medics actually triage and get countersigned by an RN. I wouldn't be worried so much about the chest pains and SOBs those pretty well get handled well. It's the abdominal pains, back pains and psychs that get blown off and come back to bite you.
 
LoneStarSoldier said:
That would be nice, but that's a no-go in my area. We don't delay transport for ANYTHING. By the time the patient is secured in the back of the ambulance and the driver is strapped in, has reported on the radio that we're en route to the receiving facility, and has recorded the times on the time sheet you should already have a BP, SPO2, Pulse, and be well into filling out your patient care form. Of course if the call isn't an emergency there can be a little deviation from this.
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Really? Are you kidding me? Do me a favor. Next time you're on shift time your pulling over to a complete stop and take a manual BP then keep timing getting back up to speed. I guarantee you it won't be nearly as long as you're afraid it might be.

Doing the right thing is what's important. When you are balls to the wall, somebody somewhere will miss something and something important. That's when your pts die.
 
usalsfyre said:
I see your point, in my area medics actually triage and get countersigned by an RN. I wouldn't be worried so much about the chest pains and SOBs those pretty well get handled well. It's the abdominal pains, back pains and psychs that get blown off and come back to bite you.
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in our are we have sitters that have to wach the psychs the whole time they are in our care. Now the Abdominal pains are required by our rules to be sceen by the MD's. Now back pains depend it just depends. I do see where you are coming from
 
usalsfyre said:
Taking a manual B/P is a vital skill. The biggest help? A good stethoscope. I'm not sure you can beat the Maxiscope for the price.
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I've looked at the Maxiscopes, is there anything particularly special about them? The description says they make it easier to hear in noisy environments but have you actually used one? You're right about the price through, pretty good.
 
Aprz said:
Well, I found some of those pages I was talking about for you.

http://emtlife.com/showthread.php?t=22749
http://www.emtlife.com/showthread.php?t=22781

And the part that I felt that was relevant to this post is...


https://emtmedicalstudent.wordpress...es-that-should-never-be-said-on-an-ambulance/

The important part to me with the NIBP v. manual is the part I bolded (except the title). If you take a manual blood pressure and you take one by machine, and they are completely different, don't discard what the machine has to say. Maybe you're doing a manual incorrectly. :D Of course, it seems like this was aimed more at things like pulse ox, EKGs, etc, but I think it still applies.
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Thanks for those links, they were heplful. After traversing those two lengthy threads, as well at the Stethescope mega-thread of 15 pages, I have come to the realization that opinions on stethescopes are like opinions of cars, firearms, movies, etc. (they're inconclusive). I do believe that there is a stethescope suited for every situation, but more often than that, there are more than one stethescope suited for every situation. I know what to steer clear of in terms of scopes, but the general consensus seems to be that of Littman, ADH, and a couple others. One of my partners has a Littman that I tried out and I liked the feel of it. But for right now, I'm still back to square one in terms of what scope that would be best for me.
 
LoneStarSoldier said:
I've looked at the Maxiscopes, is there anything particularly special about them? The description says they make it easier to hear in noisy environments but have you actually used one? You're right about the price through, pretty good.
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I don't know what's special about them, BUT, I can hear better with mine than any of the Littmans or ADCs I've owned.
 
One thing I have found to be invaluable for taking BP's in a moving ambulance is quite simple actually. First place the patients arm that you have the cuff on one of your legs and let it rest there. Then place your other leg on the folded legs of the gurney, this helps reduce road noise because your dispersing a lot of the bumps throughout the gurney. Also, if you have a double tubed stethoscope, try looking for a single tube one, as the two tubes can bump into each other and cause more noise than wanted.

Just something I picked up from one of our senior medics.
 
Leafmealone said:
One thing I have found to be invaluable for taking BP's in a moving ambulance is quite simple actually. First place the patients arm that you have the cuff on one of your legs and let it rest there. Then place your other leg on the folded legs of the gurney, this helps reduce road noise because your dispersing a lot of the bumps throughout the gurney. Also, if you have a double tubed stethoscope, try looking for a single tube one, as the two tubes can bump into each other and cause more noise than wanted.

Just something I picked up from one of our senior medics.
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This plus palpate for a (brachial) pulse and place the head of the scope over that spot. Otherwise, that is exactly how I take BPs.
 
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