MAP Question

akflightmedic

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I am googling...but in a testing situation, do you use standard rounding rules when calculating MAP?

Say the MAP calculated is 70.6....would you put 70, 71, or 70.6?

Sources for any claims would be much appreciated.

Thanks!

EDIT: For this particular question, the formula being used is DBP x 2, added to SBP and then divided by 3.

I know there are other formulas, I know HR is not being factored here.

Please address the question of round or not...
 

E tank

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The archaic ( and clueless )nature of being asked to calculate MAP in this day and age aside, just round routinely. The difference in 1 mmHg of MAP is less than insignificant so it wouldn't matter clinically at all since it will probably be different in 30 seconds anyway.

I know you're asking the question in good faith, so this snarky response is not directed at you but at a general contempt for the knuckle heads that ask this sort of thing...and I won't dignify offering a source for a such a common sense answer.
 

joshrunkle35

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The formula you indicated in the original post is the way I use to calculate it. I round down, based on the fact that some orders might include doing something if MAP increases over a certain number.

For example: give atenalol if MAP is 90 or above. If MAP is 89.7, it is technically below 90, until you round up, in which case you have to give the drug, even though it is not appropriate. So, I always round down to the nearest whole number.
 

MonkeyArrow

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The formula you indicated in the original post is the way I use to calculate it. I round down, based on the fact that some orders might include doing something if MAP increases over a certain number.

For example: give atenalol if MAP is 90 or above. If MAP is 89.7, it is technically below 90, until you round up, in which case you have to give the drug, even though it is not appropriate. So, I always round down to the nearest whole number.
But what about orders that require you to give a medication if a MAP is below a number. For example: start an epinephrine drip if MAP is below 65.
 

VFlutter

Flight Nurse
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For example: give atenalol if MAP is 90 or above. If MAP is 89.7, it is technically below 90, until you round up, in which case you have to give the drug, even though it is not appropriate. So, I always round down to the nearest whole number.
Yeah that dude with the Aortic Dissection sure appreciates you sparing him unnecessary drugs
 

Akulahawk

EMT-P/ED RN
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If I'm forced to do rounding on something this is how I do it: less than 5, round down. If greater or equal to 5, round up. How do I deal with this in the real world? I look at the trend. IF the trend is clearly up or down and getting close to some "magic number" and within a reasonable margin of error, I'll get the drug ready and as soon as I can make a case for the patient meeting parameters for giving it, I'll get it going. I'm also not beyond asking the doc for a formal order to give it given the trend.

Now then, given the pumps we have, they will round up or down depending upon how the rate is entered into it. However they'll hold a more exact rate if I tell it how much to infuse over a given amount of time... quirk in the programming that I'm sometimes all too happy to take advantage of. :cool:
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
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I am googling...but in a testing situation, do you use standard rounding rules when calculating MAP?

Say the MAP calculated is 70.6....would you put 70, 71, or 70.6?

Sources for any claims would be much appreciated.

Thanks!

EDIT: For this particular question, the formula being used is DBP x 2, added to SBP and then divided by 3.

I know there are other formulas, I know HR is not being factored here.

Please address the question of round or not...
First, 0.5 and above, round up.
Secondly, why is someone of your stature and experience asking this question? Curious.
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
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The formula you indicated in the original post is the way I use to calculate it. I round down, based on the fact that some orders might include doing something if MAP increases over a certain number.

For example: give atenalol if MAP is 90 or above. If MAP is 89.7, it is technically below 90, until you round up, in which case you have to give the drug, even though it is not appropriate. So, I always round down to the nearest whole number.
Do your parameters allow you to round at all? And if so, basic Drug Calc 101 says to round up, not down, at 0.5 and above. And if the MAP is that high, you're probably going to need to address it sooner rather than later; especially if it's trending up as another response said.
 

Akulahawk

EMT-P/ED RN
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For example: give atenalol if MAP is 90 or above. If MAP is 89.7, it is technically below 90, until you round up, in which case you have to give the drug, even though it is not appropriate. So, I always round down to the nearest whole number.
If you're following the "usual" rounding rules, given 89.7, you'd round UP. If the trend for that patient is UP and the MAP is 89.7 and parameters say give at MAP of 90, I'm going to give it. Given a pressor and I'm supposed to give it if MAP ≤ 65 and I'm seeing 65.4, technically it's not within parameters but if the trend is DOWN, I'm very likely to start the pressor because that's within margin of error for the NIBP and the trend is DOWN so the next BP measurement or so will meet parameters if I don't start the pressor...

If your rounding rules specify to round up for anything even slightly greater than a whole number, do that but also be well aware of the TREND.

Oh, and if something should be done and your parameters don't address the specific situation, you can always try to get an order to deal with that specific situation. Just be ready and able to clearly articulate your reason for asking for that particular order.
 

akflightmedic

Forum Deputy Chief
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I am asking because I am in a testing scenario. And I rounded down for clinical reasons. I need solid evidence to support why would would not round up just because the answer was 70.6 using that particular formula and those numbers.
 

Remi

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I am asking because I am in a testing scenario. And I rounded down for clinical reasons. I need solid evidence to support why would would not round up just because the answer was 70.6 using that particular formula and those numbers.
I highly doubt you are going to find any evidence to support rounding in either direction, in any scenario. There's just no way to prove the clinical significance of a fraction of a mmHg of MAP.

MAP changes literally from heartbeat to heartbeat, so I seriously cannot comprehend ever haggling over whether the MAP of 70.6 that was measured (or estimated) during a particular beat 5 minutes ago should be called 70 or 71. It's an utterly meaningless distinction.
 

akflightmedic

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Why were several posts from this thread removed?

There were many good points made, including my close out of the topic and nothing offensive was said.
 

akflightmedic

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Did not see that....TY
 

Peak

ED/Prehospital Registered Nurse
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I think in one of the posts that got lost this ended up being related to a nursing school question.

If that was correct then you probably won't win, and understand that an instructor who probably has no critical care background doesn't really appreciate the clinical significance anyway. The reality is that most nurses have zero critical care experience, and that follows into nursing schools.
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
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Umm, not true.
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
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Lack of CC experienced nursing school instructors.
 
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