taking BP

Emtgirl21 said:
so ridryder911 do you enjoy working with an EMT partener or you prefer a paramedic?
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I really don't care what level you are, and work with all levels. As long as you perform good patient care and are proficient. Being friendly to patient, families, and other members of the patient care party. I believe anyone can learn at all times, so being stagnant is one of the most hidden dangers is in this profession.


R/r911
 
And once you locate the spot, mark an X on it, makes it easier to find it again and when checking pulses anywhere on the body esp. trauma calls X marks the spot for rechecks as needed. :)
 
fm_emt said:
Palpation is also a great tool for lazy firefighters. If they hand you a sheet with vitals and the BP says "120/P" - take your own set of vitals. :)
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Palpation can be useful.... and is often better than nothing... but I'd beware any B/P that is 120/80 or 120/p!
 
Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way? I can be a little skeptical of technology at times.... :P
 
Medic's Wife said:
Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way? I can be a little skeptical of technology at times.... :P
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Depends. If I get ONE manually, and the machine gives something close, than I've got no problem. If it gives me something that is WAY off what I heard, I don't trust the machine.
 
^_^ I'll do manual BP's over auto any time, My ears have not let me down yet!
 
ok another question. when we're listening through the stethoscope, are we listening for a wheesing sound or a regular "thump"?
 
se0u1sk said:
so just to clarify

  • Put the BP Cuff on so that it inflates over the artery
  • Palpate the pulse on the wrist
  • Place the stethoscope near the artery and begin to pump the BP Cuff
  • Listen for the artery to stop beating and take the number which because the systolic pressure
  • Start releasing the pressure slowly and listen for the artery to beat again this number is the diastolic pressure
  • Release the pressure all the way, take the cuff off, record the numbers.

is that about right?
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Relatively correct... with some minor modifications. Honestlyi surprised Ryder did not comment on it.
I find it easier to get both pressures on the release of air as opposed to trying to get the systolic as your are inflating the cuff. Not only does this make your reading more accurate, but it also decreases the ammount of time that the PT has decreased or no bloodflow in their arm.

Second, the Diastolic pressure is not when you hear the sounds again. After you have inflated your cuff, you would start deflating the cuff. When you hear the sounds start, thats your systolic. Continuing to deflate the cuff, when you hear the sounds again, THAT is your diastolic pressure.

I hope this clarifies a possible missunderstanding.
 
94accord;53115 Continuing to deflate the cuff said:
I thought when the sounds stop, or change (become "dull") that was your diastolic.
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Jay114 said:
I thought when the sounds stop, or change (become "dull") that was your diastolic.
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you got me... thats what happens when you are coming off a 24 hour with only 12 hours down before another 24 lol... thank you for correcting my oversight.
 
I am in the middle of a Basic class too, and my instructor has come up with a good way to get us to practice taking vitals. He handed out a sheet with every student's name on it and spaces for their vitals. By the end of the course we need to hand in the completed sheet in order to pass. So in effect we need to take about 20 sets of vitals on all different types of people. Besides the basic respiratory rate, pulse, and BP, we are also doing lung sounds and pupils. Supposedly we have one person in the class with unequal pupils that we have to find too.

I thought this was a really easy but effective way to give everybody practice doing vitals on a variety of body types. If anyone thinks this would help them or their class, please pass the idea on to your instructor.
 
Inflate the cuff to at least 200...let the air out about 2 mm a second...the first thump you hear is the systolic. and the last thump you hear is the diastolic
 
Another good way to practice is to take your BP cuff and stethoscope and practice taking them in a moving car with your friends and family. You will be surprised at how much harder it is to listen with all of the backround noise. Another tip is once you can hear the BP, take your pen an make a small x on the spot. This way it will go a little faster when rechecking the BP. It is also a great tip when checking for pulses and you need to do rechecks for trauma and medical calls for the arms and legs. Pulses-Motor-Sensation= PMS. Hope this helps! :):):)
 
All good stuff here, and now practice, practice, practice! In addition, don't be surprised if you come up with some elevated numbers in your older (probably >30 yo) friends and family. Hypertension is truly a silent disease and many people have no idea that they are walking around with dangerous numbers.
 
Tincanfireman said:
All good stuff here, and now practice, practice, practice! In addition, don't be surprised if you come up with some elevated numbers in your older (probably >30 yo) friends and family. Hypertension is truly a silent disease and many people have no idea that they are walking around with dangerous numbers.
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Or you can get the routine call (i.e. Dialysis Txp) that turns to hell and back cause you take their BP and it's oh, say 70/40 when it's usually in the 120's over the 70's, and by the time you get to the hospital that's five minutes away it's even lower...
 
Emtgirl21 said:
been there done that
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yep, me too, ain't those the fun ones?

although, they can suck too, you've had a busy day of s:censored:ty stupid pointless calls, and then you get one last easy one that turns out to be the worst of the day

i'm sure you know that feelin...
 
Dialysis patients have a very complex medical history and these folks are sick, period. This is why it is important to montior these patients very closely pre and post dialysis treatment. Besides the fluid overload and eletrolyte issues, there could and can be also diabetic problems as well, i.e. low blood suger. There are times that these patients have too much fluild removed and they are too dry, resulting in a very low BP or their blood sugers are very low due to not eating before their treatments (they can have nausea during their treatments) Please remember that any patient can crash at any time, no matter if the call is "routine" or "bull poop".
 
Medic's Wife said:
Question- do you all find the readings from the automatic cuffs any more/less accurate than doing it the good old fashioned way? I can be a little skeptical of technology at times.... :P
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In general, less accurate. I find they tend to err on the high side fairly routinely, especially some of the older models. I've had problems at some facilities when I bring them hypotensive patients.

The newer models seem to be more accurate. I agree with what Jon said. I also find the automatic machines are great for monitoring usage, and much less useful for triage or acute care use. If I'm monitoring hemodynamic status, I'm perfectly ok using a machine that has an error tendency, as long as it's consistent.

That's the same feeling I have about BPs by palp. Just tonight I had a critical APE patient. I ended up administering 5 sublingual nitros, nitropaste, and lasix (I know... lasix is going out of style these days). Plus he was already being treated for pneumonia. I was extremely concerned about his BP, but I already had three auscultated BPs so I was perfectly comfortable with palping the rest..... at that point I'm less interested in the actual pressure than I am with monitoring his general hemodynamic status.
 
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