FlorianFred
Forum Probie
- 20
- 10
- 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.
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.
