Need some help

EMTelite

EMTelite

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Hey guys I am new to the EMS scene and I am actually actually passing my EMT class this next wednesday but I have been out on the rig a few times and a few times with the fire department as well just trying to get my feet on the ground but I have noticed that I am fine with my patient assessments and everything but the one thing that is really challenging me is my BP I have a real hard time trying to find it when I am on the rig does anyone have any tips they could offer me I know this sounds like a stupid question to be asking but honestly thought I could learn from some vets such as yourselves


Thanks you guys
 
probie here too

Im also almost done with my bls class, and if i may offer a tip my medic taught me, pump the cuff up too 200, then let it drift back down, this will cause the brachial pulse to pund making it alot easier to auscultate
 
The ONLY way to get better at hearing a BP in a rig is to do it over and over again.


One way to make it easier is to rest the pts arm on your leg, fully straight, and put the stetho right on the crease of their elbow.
 
And yes practice over and over again on a rig is the only way to get better at it
 
garett1979 said:
Im also almost done with my bls class, and if i may offer a tip my medic taught me, pump the cuff up too 200, then let it drift back down, this will cause the brachial pulse to pund making it alot easier to auscultate
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Bad idea, each patient isn't the same. Are you going to pump up the cuff to 200 on a 90lbs nothing old woman?


OP: Put your feet on the stretcher, not sure why it works. But it does.
 
garett1979 said:
well true every pt is different in that situation, what would you recomend?
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Do what you were taught--- Pump the cuff up until you can no longer hear the thump, do 1 more pump for good measure, then release the air slowly until you can hear the thud. When you heard the thud, remember the mmHg mark, then continue until the thud changes tone / disappears, and remember that mmHg, and you than have your BP.


Remember, the thud need no go away for you to have your diastolic blood pressure... if it changes tone but doesn't go away, that change is your lowest pressure.
 
Actually when I went out with an FTO he said pump it up to 220 because the pain from the cuff isent really that bad and he said that way you are going to catch if they have a significantly high BP
 
Frig I hate half assed justifications like that. Way to wide a brush for all circumstances and it creates bad habits.

How far do you need to pump it up? First you need to stick with how you were taught and listen, even a bit on the way up. Second, background noise makes this difficult to consider their clinical condition. History of hypertension, expect it to be higher than average. Meds include both a CCB and HCT, even more so as the multiple antihypetensives tell you their BP likely wasn't responsive to one. Elderly lady with a presyncopal episode, pale, diaphoretic, reporting dizziness? Safe bet that her BP is not going to need you to go within shouting distance of 220mmHg.

Second, consider Karotkoff sounds. Knowing the sounds and where they fall along the pulse pressure range will let you know if you're getting close to the end and allow you to slow down the rate you release the air at.

Third, don't be afraid to pump it back up a bit. Zeroing in on those numbers can be hard sometimes. If you think you missed it, don't be afraid to give the bulb a squeeze, jump up past it and listen closely. Beats having an inaccurate BP or doing it again.

Fourth, with the arm extended and resting on your lap, place a pillow underneath to isolate it from some of the background noise.
 
if you have a problem hearing it to begin with you can always feel for a pulse in the antecubital fossa (the inside of the elbow), then you will know exactly where to put your stethoscope. then your next step is to pump up the cuff, while still palpating the pulse until you cant feel it anymore, then pump up the cuff a little bit more. at this point replace your fingers with the bell of the stethoscope then release air out slowly. take your time. usually there is no rush. yes this way takes longer but it allows you to figure out exactly where the pulse is, ie where to place your stethoscope, and gives you an idea of how far you need to pump it up to. i hate the pump it up to 200 or 220 on every patient
 
EMTelite said:
Hey guys I am new to the EMS scene and I am actually actually passing my EMT class this next wednesday but I have been out on the rig a few times and a few times with the fire department as well just trying to get my feet on the ground but I have noticed that I am fine with my patient assessments and everything but the one thing that is really challenging me is my BP I have a real hard time trying to find it when I am on the rig does anyone have any tips they could offer me I know this sounds like a stupid question to be asking but honestly thought I could learn from some vets such as yourselves


Thanks you guys
Click to expand...

Another good way to do a BP on a rig is by Palpation. I found this to be very good way of getting a BP on the rig because I run up and down bumpy roads and it is hard to hear it. Hope this helps.

B)
 
very true....i love getting BPs by palpation....but sometimes you do need the diastolic throughout your call
 
Practice, Practice, Practice.

Congrats on geting your cert, welcome to the group.
 
LAS46 said:
Another good way to do a BP on a rig is by Palpation. I found this to be very good way of getting a BP on the rig because I run up and down bumpy roads and it is hard to hear it. Hope this helps.

B)
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This is a very bad practice. I have failed students for taking a Palp BP!;)
 
While palpated blood pressures do indeed have their place, they are no substitute for an auscultated one.
 
reaper said:
This is a very bad practice. I have failed students for taking a Palp BP!;)
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Why? It's common practice, used by everyone from B's to Docs, and does the job of getting a systolic in a noisy place or with a pt that you can't auscultate for some reason.
 
Linuss said:
Why? It's common practice, used by everyone from B's to Docs, and does the job of getting a systolic in a noisy place or with a pt that you can't auscultate for some reason.
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I agree that it is a common practice, and do not agree with failing a student for it. However at some point on a call you DO NEED to take an auscultated blood pressure. So you do need to be able to do it, reliably might i add, in any situation.
 
omak42 said:
I agree that it is a common practice, and do not agree with failing a student for it. However at some point on a call you DO NEED to take an auscultated blood pressure. So you do need to be able to do it, reliably might i add, in any situation.
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Oh I'm not arguing that at all.

I'm arguing the "fail" that he gives people for doing it.
 
Thanks

Thanks guy honestly all of these tips have been very helpful, I really appreciate the help I think a lot of it is just going to have to consist of me practicing my butt off just doing it a controlled environment and then in the car but like I said I really appreciate all the help
 
The other day I picked up a patient with a BP of 254/176 so by pumping it up to either 200 or 220 you both just failed.

The problem most people have taking a BP in the rig is differentiating between the sounds of the pulse and background sounds from road noise etc. Over time you learn the difference in them but a good practice for beginners is trying to minimize these background noises. Get your butt as far off the edge of the bench as you can, either pick your feet up or roll up so you're just on the balls of your feet, hold their arm up or rest it on your leg but don't let it rest on the cot. By doing that you will have less contact with the rig minimizing the amount of noises you pick up.

Another trick you can use once you learn your area, you will know which roads are pretty rough and nearly impossible to take a BP on and which roads are kept up a little better. There is also nothing wrong with waiting until a stop light or stop sign to take a BP on most patients. On a real critical patient you have to get it done, if you can't then palpate but on non critical patients waiting 2 minutes until a stop sign won't be a big deal.
 
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