Paraplegic and vitals

[Sassafras]

Tough case. All limbs paralized and hypertonic. Pulses hard to find, blood pressure almost impossible to hear. I could not hear it once in the truck and the engine was running. I ended up using my stethoscope over the patient's chest to get heart rate (which did coincide with pulse ox pulse but I don't just trust machinery without something to trend with in the back of a moving vehicle). Patient non verbal hx of traumatic brain injury and could not tell if he was in pain. Sooooo, with that in mind, trending him was difficult. Is there a trick I'm missing to b/p on a paraplegic? I've not run into a situation where every place I tried gave me trouble.

 

[Sasha]

Yup, go hunt down one of the CNAs and have them take it for you. Or you can always ask the family/caretaker "Where do you usually take his/her blood pressure?"

 

[Veneficus]

Tough case. All limbs paralized and hypertonic.

Quadriplegic?

Patient non verbal hx of traumatic brain injury and could not tell if he was in pain.

How did you assess his reaction to painful stimuli when you recorded his GCS?

Sooooo, with that in mind, trending him was difficult. Is there a trick I'm missing to b/p on a quadriplegic? I've not run into a situation where every place I tried gave me trouble.

Did you do the guy a favor and put the cuff around his neck? h34r:

(sorry couldn't resist)

He probably had a foley or a chart. What was his urine output?

If the urine is full, surgical drainage empty, and patient responding as normal, chances are the BP is doing fine.

 

[Sassafras]

On phone forgive if answers are hard to read.

Quadriplegic?Yes





How did you assess his reaction to painful stimuli when you recorded his GCS?
Patient was awake. He could make eye contact for brief moments before losing muscle control. Actually did not assess pain other than palpating abdomen and babinski reflex. Brain injury ten years ago. Did not feel inflicting intentional pain to prove to myself he was actual paralyzed was appropriate since it is well documented. Pt did cry out when nurse removed urine bag from penis.



Did you do the guy a favor and put the cuff around his neck? h34r:

(sorry couldn't resist)

He probably had a foley or a chart. What was his urine output?

If the urine is full, surgical drainage empty, and patient responding as normal, chances are the BP is doing fine.

 

[Sassafras]

Regarding foley. I had not seen it before. I have seen catheters but this was like a condom attached to the tubing going to the urine bag. Similar just nothing inserted into the urethra. It was removed when we arrived for transport and a depends/brief/diaper was placed on. I sort of took that basic approach though that you suggested minus urine output since I didn't remove it to look. Other vitals remained consistent. I was just hoping for some tips from the masters here.

Oh and the cuff around the neck thing is only for when I'm checking my husband's bp.

 

[abckidsmom]

Regarding foley. I had not seen it before. I have seen catheters but this was like a condom attached to the tubing going to the urine bag. Similar just nothing inserted into the urethra. It was removed when we arrived for transport and a depends/brief/diaper was placed on. I sort of took that basic approach though that you suggested minus urine output since I didn't remove it to look. Other vitals remained consistent. I was just hoping for some tips from the masters here.

Oh and the cuff around the neck thing is only for when I'm checking my husband's bp.

Condom catheter. Better for skin integrity without the risk for infection of a foley cath.

Just document the rest of the circulatory assessment.

 

[Veneficus]

On phone forgive if answers are hard to read.

YOu don't use GCS to prove paralysis. You use it for prognotic indication of brain function. But it can also be used in an abstract way to measure mental status. Good mental status is a sign of good perfusion.

You can also use GCS as a measure of whether or not the patient is in pain. If there is no reaction at all to painful stimuli and the lower the GCS, the less likelyhood for pain.

If you knew he was paralyzed I am not sure why you performed a babinski.

baseline mentation seems intact, urine output, and no drainage from tubing, sounds like the patient was doing fine.

 

[Sasha]

Regarding foley. I had not seen it before. I have seen catheters but this was like a condom attached to the tubing going to the urine bag. Similar just nothing inserted into the urethra. It was removed when we arrived for transport and a depends/brief/diaper was placed on. I sort of took that basic approach though that you suggested minus urine output since I didn't remove it to look. Other vitals remained consistent. I was just hoping for some tips from the masters here.

Oh and the cuff around the neck thing is only for when I'm checking my husband's bp.

Texas Condom Caths. The first time I saw one the patient had pulled it off, and we had already moved him over before we discovered it wasn't a foley. Big freak out moment, I thought we had some how pulled a foley out, and then it clicked.. Hey no signs of trauma. Uhm this is weird!

Several different catheters or catheter looking things, it can get confusing.

 

[firetender]

All limbs paralized and hypertonic.
IS A QUAD
Pulses hard to find, blood pressure almost impossible to hear. I could not hear it once in the truck and the engine was running.
TURN OFF THE ENGINE
I ended up using my stethoscope over the patient's chest
GOOD MOVE!
Is there a trick I'm missing to b/p on a paraplegic? I've not run into a situation where every place I tried gave me trouble.

You DID establish a baseline and learned how best to accomplish that.

Hopefully, you also paid very strict attention to the appearance of the patient, including...he WAS breathing, wasn't he? How?

The point here is once you established a baseline and get real clear on the appearance of the patient, ALONG WITH VITAL SIGNS, all the rest is about observation of any changes. You really DON'T need instruments to detect changes, if you sharpen your eye you can SEE them.

In doubt? Pull that rig over Partner and shut the engine!