Popliteal Blood Pressure

[Mlaz]

Hi everyone, this is my first post, but I've been a long time reader of this incredibly helpful forum.

I had a question regarding training and field experiences regarding popliteal blood pressure. A colleague of mine had mentioned that there could be situations where I may need to take a popliteal (behind the knee) blood pressure measurement such as if the person is unable to move one or both arms and/or they have a fistula in the only available arm. He said it would be the most common in elderly calls.

I have never had to do this in the field, nor have a few of the other guys that I asked. I don't remember this coming up at all during training either.

Is popliteal blood pressure measurement a skill that is taught in other programs?

How often (if ever) have you guys had to take a popliteal BP measurement?

 

[EpiEMS]

Not since my initial class. It's taught, but...I haven't used it. For that matter, I've used a thigh blood pressure cuff on more (large) arms than thighs.

 

[Gurby]

I've never done it but I guess it's nice to know the option is available. You can also auscultate the posterior tibial artery if you put the cuff just above the ankle, but you are at risk of getting low numbers if the person has peripheral vascular disease...

 

[EpiEMS]

auscultate the posterior tibial artery if you put the cuff just above the ankle

Ooh, I like that one. "Hey, newbie, you ever taken an ankle BP?"

 

[Tigger]

Do babies on an autocuff count?

 

[Gurby]

Ooh, I like that one. "Hey, newbie, you ever taken an ankle BP?"

You could also palpate the systolic via dorsalis pedis, theoretically, if you wanted to, and assuming the patient doesn't have PVD (which they almost certainly do, I guess, if they have no arms available for taking a pressure on...)!

 

[Mlaz]

This was extremely helpful, thank you everybody!

 

[Aprz]

I didn't see this thread earlier this month. I had a patient recently with both of her arms contracted (History of hemorrhagic stroke and dementia, normally does not speak, but if she does, it is one to two words. Grimacef to painful stimuli, but eyes remain closed. Baseline neurological/mental status per the family. We were there because she had a fever since the previous night). For our county, we are suppose to take a manual heart rate and blood pressure first, and usually my EMT partner does it for me. I told her to try to auscultate it at the wrist, but she ended up just palpating (she didn't try to auscultate it). Neither of us thought of doing it at the feet during the call. After the call, we were talking about doing blood pressures at difference places, and I was telling her that you should technically be able to do it anywhere that has a pulse. I felt the patient's feet would've been great because it wasn't contracted, and it is actually where I started the IV at too. I tried to auscultate with my own feet at the dorsalis pedis and posterior tibilias, but that didn't work well at all. I think I may have heard it, but it was not definitive. I then tried the popliteal, and that actually worked surprisingly well. My only complaint is that the blood pressure there was extremely uncomfortable even at 40 mm Hg, and it was pretty untolerable around 160 mm Hg for me. I did it on my partner, and she agreed it was super uncomfortable. It's the only time I've ever tried taking a blood pressure in the feet/legs. I've unsuccessfully tried wrists before too.

 

[Summit]

Never done an auscultated popliteal pressure outside class... I've palped some on rare occasion... plenty of the automated equivalent (thigh)... plenty wrist (radial) and calf (PT) autocuff and palps

 

[Bullets]

Ive done it once, but my go to is the ankle BP if i cant get a forearm. Anywhere you can occlude blood vessel and listen distally you can get a BP. Just about being creative and knowing your vascular anatomy

 

[E tank]

Been following the thread...may be a no brainer, but any bp taken below the level of the heart should be in a supine (not sitting/fowlers) patient for the most accurate measurement as the pressure measured will be higher if not...

 

[Mlaz]

Has anyone heard of responders that have actually broken a patient's arm trying to get a blood pressure from a stroke victim whose arm was spastic/locked up? I heard a story about this happening when there was a call and the patient's other arm had a fistula so they just forced the other arm open to get the BP, resulting in a bad time. Not sure if that is just an old-wives tale or someone could actually be that crazy.

 

[luke_31]

Has anyone heard of responders that have actually broken a patient's arm trying to get a blood pressure from a stroke victim whose arm was spastic/locked up? I heard a story about this happening when there was a call and the patient's other arm had a fistula so they just forced the other arm open to get the BP, resulting in a bad time. Not sure if that is just an old-wives tale or someone could actually be that crazy.

Never heard of that, but if you are having to apply that much force, I'd stop and find a different spot to take a blood pressure.