Defending the practice in other forums?
Nah, not really. I was given an assignment to do some "out of the box" thinking on clinical treatment tips. For the first three topics, I chose auscultatory percussion of long bone fractures, assessing tactile vocal fremitus, and alternative uses of pulse oximetry.
First, I think the pulse oximeter is a vastly misused piece of equipment, and secondly, I think there are other ways to utilize it, with the caveat that you shouldn't place absolute faith in the results you get. At best, it's a stopgap measure, a trick you try when nothing else works. I thought the article had made that clear, but apparently not.
I enjoy the discussions, actually. You guys are pointing out some flaws in my reasoning, and I appreciate that. That's what the comments section after the post is for, as well as discussion forums like this one.
On the other hand, let me offer a few clarifications:
1. The consensus seems to be that I recommend this trick for everyday use. I don't. I try it when I can't auscultate or palpate one conventionally. It's pretty rare that I can't palpate a pulse when the plethysmograph gets a good tracing, but it *has* happened.
2. I don't walk into an ER and confidently state, "The patient's BP is XX systolic," when I've done this. Instead, I do what I usually do when I can't obtain a decent BP, which is to say, "I could palpate or auscultate a BP (due to whatever reason), but I did manage to get one number this way (by the method described)."
To my mind, that's better than saying, "Couldn't get a BP," although I'm not shy about saying just that. Sometimes you simply can't. Heck, there have been times when I've said, "Blood pressure? Hell, I'm still working on airway!"
3. My ears suck, from childhood trauma and two tympanoplasties to years of shooting without ear protection, I have measurable deficits through all frequency ranges in both ears, but more so on the left. As a result, I'm one of those stethoscope snobs who has to carry his own high dollar scope, and guards it with his life. The other thing that necessitates is that I auscultate my blood pressures on scene, because road noise makes it almost impossible to hear in my sickest patients.
So yeah, once I'm in the rig, I palpate pressures a good bit, or use the NIBP. I always figured it went without saying that I auscultated a pressure with my own ears (or a partner I trusted), before I used either of those methods.
It's all good in theory to advise someone to never palpate a blood pressure, or if you do, "train your fingers to be more sensitive," but that breaks down in real life. When you can't hear for whatever reason, you palpate a blood pressure. And if you've never unsuccessfully tried to feel a radial pulse in a patient you *knew* had one, my hat's off to you, because either you haven't been working on a rig long, or your fingers are more sensitive than mine. If the latter is the case, a career as a concert violinist might make you more money than a medic. You're wasting your talents here.
4. When I'm titrating pressors, I prefer to have an art line. But since the docs sending those patients have this nasty habit of not bowing to my wishes every time, I frequently transport them without one. When that happens, refer to point #3. And when I get a NIBP reading that doesn't fit the trend or seems grossly wrong, also refer to #3. If necessary, I'll have my partner pull the rig over so that I can get a decent shot at auscultating a pressure. In other words, I use whatever works.
5. The modified scrotal lead remains an excellent trick to play on rookies. Try it some time!
Welcome to EMTLife, by the way...