Palpating a BP

FlorianFred

Forum Probie
14
7
3
I ran across a situation on a recent MVA scene, and after a brief and professional exchange on the event with the EMS provider, I came away confused and a bit concerned. The scene was a 1-vehicle MVA wherein the vehicle left the road and went nose-down into a deep ditch. There were two individuals in the vehicle, both PTs had exited the vehicle on their own prior to fire and ems arrival. EMS response was a BLS ambulance, and in our neck of the woods, BLS doesn’t typically carry a cardiac monitor (which is how most of our ems providers take BP), so a BLS crew member grabs a manual sphygmomanometer, but no stethoscope. I ask, “so you’re going to palpate the BP” and they reply, “yeah, I can feel better than I can hear”, and I say, “yeah, I get that; but you only end up with a systolic.”; and that earns me a funny look.

So I watch while the BP is palpated….fingers on the wrist for the radial and the cuff gets inflated. I’m watching the needle go up, stop, pressure is released slowly, the needle is bouncing on the way down, and I hear the provider give their partner a systolic and diastolic. And the pulse pressure is narrow – separated by less than 20 points; but the PT doesn’t appear shocky to me (skin color and temp are normal), and I can’t figure out how the provider got a diastolic off a palpation. The second PT gets their BP the same way, and the pressure is narrow, but closer to 30 pts difference. So I approach the provider away from the PTs and ask how they got a diastolic, and honestly, I couldn’t follow their answer. It appeared to me that they were watching the reading closely, and when the radial pulse disappeared, called that the systolic and then took the reading for when the pulse returned and called that the diastolic (which would be the actual systolic). The conversation remained cordial and professional, but I couldn’t let it go, and I planted enough doubt in their mind that they asked their supervisor (which they had to call anyway to be able to get authorization to transport both PTs). The provider came back after the call and told me that they checked with their supervisor and that you could get both a systolic and diastolic pressure from palpation, and that they did it correctly.

I was holding things up with my doubt and questioning, so I dropped it and helped them load the PTs and get them on their way. I then ran home to my friend “Google” and actually found several articles – one from JAMA back in 1996 titled “Diastolic Blood Pressure Can Be Reliably Recorded by Palpation”. So here are my 2 questions:

1. Is palpating a full BP reading (systolic and diastolic) something that you do, or is in your “toolkit” or protocols?
2. If the answer is yes to the above, how do you do it? And how reliable/accurate is it?

My EMT instruction made it clear that you could only get the systolic from a palpated BP, and there wasn’t a hint of finding/extrapolating/discovering a diastolic pressure. I’m going to follow up with the next ALS crew I see (assuming the scene allows) and see if it’s a protocol or technique that they are trained on in their service; but I wanted to ask here as well.
 

Aprz

Non flying critical care flight attendant
2,998
642
113

E tank

Caution: Paralyzing Agent
1,506
1,335
113
There are later papers than that:

But the real question is 'who cares?' In the setting of this forum, the only pressure that matters is the systolic relative to the patient's physical exam, moi, blood loss etc. If someone is in the position completely not to be able to listen to sounds, they're likely not in any position to do anything about or interpret a 'worrisome' diastolic blood pressure. If the crew were really bent on getting a systolic over diastolic pressure, they'd just load up, close the doors and listen.
 

EpiEMS

Forum Deputy Chief
3,774
1,119
113
Color me very suspicious about the reliability of the supposed literature…N’s are small and methodology looks at the very least suspect / subjective.

That said, agree with the above - probably not much of the clinical decision making here is driven by DBP - it’s SBP that drives the trauma triage criteria, etc.

It also sounds like you may have encountered some lazy providers.
 

DrParasite

The fire extinguisher is not just for show
6,083
1,972
113
EMS response was a BLS ambulance, and in our neck of the woods, BLS doesn’t typically carry a cardiac monitor (which is how most of our ems providers take BP), so a BLS crew member grabs a manual sphygmomanometer, but no stethoscope.
You know, if your EMS providers are unable to take a manual BP, that's a bigger issue....

So here are my 2 questions:

1. Is palpating a full BP reading (systolic and diastolic) something that you do, or is in your “toolkit” or protocols?
2. If the answer is yes to the above, how do you do it? And how reliable/accurate is it?
As for 1, you should ALWAYS attempt to get a full BP reading. If you can't get it, well, you tried. Note: I didn't say your first BP needed to be complete, as in this case, I might not even get a BP, and use the old "if they have radial pulses, they aren't dying immediately" as my method of triage. I know it's not the most accurate method, but this is triage, not assessment and treatments.

If you asked their supervisor, at the scene, I'm pretty sure the supervisor simply wanted this annoying bystander to go away, and backed his people. No offense to you, but if I'm at a scene, and a random bystander or student is questioning what I am doing... I'm likely going to have the nearest LEO remove you from the scene. And if you start bugging my captain, or a supervisor, they are going to request the same.

As for how accurate is it... does it really matter? As others have said, I'm more worried about the systolic than the diastolic, at least in this situation. Now, if one of them is grossly diaphoretic, looks like crap, and has no radial pulses, that's a different story. But in the situation you describe, outside of the car, it's find.

As for 2... think about how many of the population have different levels of hearing loss, as well as different quality of stethoscopes out there... how accurate are your auscultated BPs, at least between two different providers with different stethoscopes? As long as they don't conflict with the clinical presentation, use it.
 

Martyn

Forum Asst. Chief
649
68
28
In training I was taught that when you take a BP the normal way it is written 124/68, if you palpate a BP then it is written down 124/P... THEREFORE, NO DIASTOLIC!
(Lowest BP I have ever taken was 54/P, little old lady who was AOx4 chatting away)
 
Top