Taking BP and pulse in the ambulance

Originally Posted by MrConspiracy View Post
BLS vitals:

http://www.emtlife.com/showthread.php?t=5997 and http://www.emtlife.com/showthread.php?t=5909 Tips for taking BP and other vitals in the back of an ambulance
http://www.emtlife.com/showthread.php?t=5474 Another thread about automatic BP monitoring; reasons why you shouldn't rely on it
http://www.emtlife.com/showthread.php?t=12749 BP and mastectomies
http://www.emtlife.com/showthread.php?t=12656 A short thread on dialysis graft/fistula sites. Useful if you work for a private.

Pulse points: I've seen a few short threads, but I'll summarize. Practice when not at work, and if you're really unsure and they don't look dead, auscultate (over the heart, that is). For practice, it helps to start with someone skinny and, once you know where everything is, to try a variety of patients.


Edit sorry this one above to be clear :)
 
get on as many runs as you can for practice. what really helped me was watching for the needle bounce and stablizing the pt's arm on my thigh.

If you keep having troube there is a "simple" solution, the ZOLL M-series....automatic NIBP and pulse/SaO2
 
TraprMike said:
well, I tryed all these methods.. feet on streatcher, feet off floor. can't hear crap.. and something simple as resperations.. bouncing around on streatcher. jiggling of chest parts... (nice way of saying fat and boobs) makes it hard to detect the resp's... ahhh... going crazy..
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I thought I was the only one, I've done 2 days in a rig and have all the same trouble as you, so your not alone. I think it is just a thing that requires more experience.

Of course the company I work for gave me a cheap steth, I think i better go get a real one :)
 
I can definitely relate to the problems regarding the BP in the back of a rig, what I was advised was just what ever method you use, i.e. needle jumps, monitor, or the good ol' way with a steth, just be consistent, if you get baseline with needle jumps get your next sets the same way.
 
Bloom-IUEMT said:
Wait...what? :wacko: You have to use the carotid when you take BP using the neck right? Lol joking.

I have the same problem though. I usually watch for the bounce of the sphygmomanometer needle that begins with systolic and stops at the diastolic.
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I usually put the BP cuff around the neck and palp the carotid pulse :P

I'm still trying to master the skill of taking a BP in a moving ambulance. I was told to either close my eyes and to have the patients arm on my thigh when I'm taking BP.
 
Forgive me for asking if the reason is obvious, but why are digital cuffs not used in the ambulance?
 
Well after about a 5 days in the rig I've gotten a lot better. I'm more confident in my BP taking. I still have some problems finding weak pulses while the rig is going.

I was told to start bumping the cuff up while coming to a stop light and when then take it while the rig is stopped, which is quite helpful.
 
Sandog said:
Forgive me for asking if the reason is obvious, but why are digital cuffs not used in the ambulance?
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Some places have NIBP, some places don't, it really depends on if your company is willing to pony up the dough.

However, every first BP should be manual.
 
For stable patients, get a BP before you leave the scene and one right before you unload at your destination... grabbing NIBP vitals from the ER monitors can get you by in a pinch.
 
This just hit me... what's the utility of grabbing a NIBP at the hospital? After all, you're at the hosptial. It's not affecting any of your decision making since, well, you're already handing the patient over.
 
JPINFV said:
This just hit me... what's the utility of grabbing a NIBP at the hospital? After all, you're at the hosptial. It's not affecting any of your decision making since, well, you're already handing the patient over.
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I've seen some lazier and less scrupulous emergency medical professionals take all the vitals from the hospital because they'd not gotten their own. However, I doubt that was the point.
 
I tend to have a problem getting vitals in the ambulance especially when your going Code 3 or you hit a ton of bumps in the road. It's to noisy so i will usually just palp a pressure if i can't hear it after two or three trys. I will usually try to get a BP when im at a stop light because if your quick at it and you have enough time you can just knock it out while your stopped. I keep hearing that getting vitals such as BP and checking there pulse in the rig while your moving just takes time and a little experiance. I'm sure after awhile of doing it you'll learn to drown out the sounds around you as much as possible.
 
I just learned how to do BP the other day in my EMT-B course. It seems rather simple, but doing it on a rig with chaos/traffic noise pollution seems pretty tough. Excited to do it, thought!
 
vienessewaltzer said:
I just learned how to do BP the other day in my EMT-B course. It seems rather simple, but doing it on a rig with chaos/traffic noise pollution seems pretty tough. Excited to do it, thought!
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It's nothing like the class-room setting. I remember when I learned to do BP for the first time. My dad was so pissed that I kept taking his blood pressure all the time, he hid my stethoscope.
 
I don't know if it's been mentioned about BP and Pulse. But when i'm taking BP, I freeze the needle and count the lub dub's i hear for six seconds, then multiply by ten, and then continue my BP.

I now has a pretty accurate pulse, and of course bp
 
Fbarba123 said:
I don't know if it's been mentioned about BP and Pulse. But when i'm taking BP, I freeze the needle and count the lub dub's i hear for six seconds, then multiply by ten, and then continue my BP.

I now has a pretty accurate pulse, and of course bp
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Thats a pretty fast and loose way of taking BP, NR minimum is 15 seconds and you never watch for needle bounce, your reading can be off as much as 20 points this way, a patient could have a BP of 80/70 but watching for needle bounce you may read it as 100/70 which is a huge difference, imagine assuming your patients BP was 100/70 only to find out that your patient has been i decompensated shock for the full 20 minute ride to the hospital.. As far as the 6 second times 10 rate again you get alot of room for error. We examined it once and found that using 6 seconds times 10 had an average discrepancy of 10 BPM as oppsed to 15 times four had an average of 3-4 and 30 times 2 had an average discrepancy of only 1-3 compared to a full 60 seconds.

if you cant hear the pulse just go with the palpation method of obtaining a BP, 90% of the time you uses this technique anyway.

no offense to your technique but it seems fairly risky to me.
 
Focallength:

I don't count needle bounce for my BP, as you stated, it's way to risky. i just freeze the needle and count lub dubs for a few seconds for a pulse, then unfreeze the needle to continue my bp by means of ascultation. I do this only when i'm strapped for time. most of the time, i take pulse radially.
 
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