So I'm sitting in AMLS class...

[Veneficus]

Trust me Vene, I know. I nearly picked a fight, then backed down and got lectured on how it is our job to treat the symptoms and transport. We aren't there to treat the underlying problem, and shouldn't waste time trying to figure out what it is.

I nearly walked out.

And this cretin is teaching...

There is no hope for EMS.

 

[MrBrown]

Brown is lost a bit .... was it being taught a BP of 68P was not possible and mag and glucagon were not permissible for asthma and beta blocker overdose?

Did Brown miss something?

 

[usafmedic45]

was it being taught a BP of 68P was not possible

There's an old myth that persists in the US that you can "estimate" a BP based upon the presence or absence of various peripheral and central pulses. The most common variation I hear is that you have to have a pressure of 60mmHg systolic for femoral, 70mmHg systolic for radial, 80 for brachial and 40 or 50 mmHg for carotid pulses to be present. It's like the myth of clinically relevant hypoxic drive: it just refuses to die.

 

[usafmedic45]

I admit I know what it is because I had a patient with it.

I used to date a girl with the "benign" hypermobile form. Softest hands on the planet and flexible enough to....well....let's just leave it at that.

dermatosporaxis, kyphoscoliosis, and vascular.

Arthrochalasis, classical and hypermobile are the other three. However, it is common for there to be "mixed" forms.

 

[medicRob]

There's an old myth that persists in the US that you can "estimate" a BP based upon the presence or absence of various peripheral and central pulses. The most common variation I hear is that you have to have a pressure of 60mmHg systolic for femoral, 70mmHg systolic for radial, 80 for brachial and 40 or 50 mmHg for carotid pulses to be present. Ic drive: it just refuses to die.

I remember a "Beyond the Basics" article on Vital Signs in EMS World (Then EMS Magazine) that touched on the topic, and I quote:

" EMS personnel are frequently taught that pulse location (radial, brachial, femoral or carotid) correlates with the estimated systolic blood pressure. It is postulated that a systolic blood pressure of 80-90 mmHg is needed to produce radial pulses, a systolic blood pressure of 70 mmHg is needed to produce femoral and brachial pulses, and a systolic blood pressure of 60 mmHg is needed to produce carotid pulses. Be careful when interpreting this finding. One article found that trauma patients with a radial pulse had a mean systolic blood pressure (SBP) of 72.5 mmHg; 83% of the trauma patients with a radial pulse had a SBP of less than 80 mmHg. Trauma patients with a femoral and carotid pulse had a mean SBP of 66.4 mmHg; 83% of the trauma patients with a femoral or carotid pulse had a SBP less than 70 mmHg. It is necessary to have a SBP of 60 mmHg to produce a carotid pulse."1


References

1. Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ 321, 673-674, 2000.

Article Source:
http://www.emsworld.com/print/EMS-World/Beyond-the-Basics--Interpreting-Vital-Signs/1$4655

 

[Aidey]

Done, thank goodness. Not sure it was worth the resume padding.

usaf...*shakes head*

Rob, I'm totally stealing that duck quote.

 

[medicRob]

Done, thank goodness. Not sure it was worth the resume padding.

usaf...*shakes head*

Rob, I'm totally stealing that duck quote.

Thank Justin Schorr (The Happy Medic) for that one.

 

[usalsfyre]

I hope the course eval reflected your true feelings?

 

[Scott33]

I remember a "Beyond the Basics" article on Vital Signs in EMS World (Then EMS Magazine) that touched on the topic, and I quote:

" EMS personnel are frequently taught that pulse location (radial, brachial, femoral or carotid) correlates with the estimated systolic blood pressure. It is postulated that a systolic blood pressure of 80-90 mmHg is needed to produce radial pulses, a systolic blood pressure of 70 mmHg is needed to produce femoral and brachial pulses, and a systolic blood pressure of 60 mmHg is needed to produce carotid pulses. Be careful when interpreting this finding. One article found that trauma patients with a radial pulse had a mean systolic blood pressure (SBP) of 72.5 mmHg; 83% of the trauma patients with a radial pulse had a SBP of less than 80 mmHg. Trauma patients with a femoral and carotid pulse had a mean SBP of 66.4 mmHg; 83% of the trauma patients with a femoral or carotid pulse had a SBP less than 70 mmHg. It is necessary to have a SBP of 60 mmHg to produce a carotid pulse."1


References

1. Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ 321, 673-674, 2000.

Article Source:
http://www.emsworld.com/print/EMS-World/Beyond-the-Basics--Interpreting-Vital-Signs/1$4655

Here is a little more of Charles Deakin's study. Amazing to think it was conducted over a decade ago, but to be fair, it's not just the US that still teach it.

http://www.bmj.com/content/321/7262/673.full.pdf

 

[medicRob]

Here is a little more of Charles Deakin's study. Amazing to think it was conducted over a decade ago, but to be fair, it's not just the US that still teach it.

http://www.bmj.com/content/321/7262/673.full.pdf

Thanks, Scott33. I am kind of ashamed to say that I have never read this particular study in its entirety, only excerpts seen in selected articles such as the one I referenced above by Mistovich, Limmer, and Krost.

 

[EMTinNEPA]

Mag for asthma? Huh how does that work? Glucagon for BB OD? Does that work?

Magnesium sulfate can act as a bronchodilator and is associated with a lower rate of hospital admission. While is it shown to be effective in treating bronchospasm, it's not indicated in mild asthma exacerbations.

Glucagon has long been an "accepted" off the label medication for a beta blocker overdose. There are paramedics in parts of this state that actually start glucagon drips on beta blocker ODs.

 

[Veneficus]

Magnesium sulfate can act as a bronchodilator and is associated with a lower rate of hospital admission. While is it shown to be effective in treating bronchospasm, it's not indicated in mild asthma exacerbations.

It also blunts T cell response.

Mag is one of the oldest drugs known to man and has a myriad of uses. My favorite is to sedate psych patients with it. Though Psych doesn't like that at all since they sleep for about 20 hours.

Glucagon has long been an "accepted" off the label medication for a beta blocker overdose. There are paramedics in parts of this state that actually start glucagon drips on beta blocker ODs.

With perhaps the exception of accidental OD in peds, I don't think it is a good idea to start acutely reversing beta blockers in the field. Especially on people who have been on them for significant time.

 

[usalsfyre]

Per one of our ED docs poison control isn't even recommending glucagon in beta blocker overdose anymore, it's high dose insulin and glucose.

 

[Aidey]

Magnesium sulfate can act as a bronchodilator and is associated with a lower rate of hospital admission. While is it shown to be effective in treating bronchospasm, it's not indicated in mild asthma exacerbations.

Glucagon has long been an "accepted" off the label medication for a beta blocker overdose. There are paramedics in parts of this state that actually start glucagon drips on beta blocker ODs.

So yeah...I was being b!tchy and mocking my classmates.

 

[usafmedic45]

My favorite is to sedate psych patients with it. Though Psych doesn't like that at all since they sleep for about 20 hours.

Really? Man I need to remember that the next time I need to catch up on sleep. LOL

 

[EMTinNEPA]

So yeah...I was being b!tchy and mocking my classmates.

Oh. My bad.