Trick to hear BP Better in the Moving Rig???

[DesertMedic66]

I couldn't get a bp on a pt the other night in the back of the ambulance and asked the als person on board to try. He got one. Afterward he told me to auscultate the brachial pulse before putting on a bp cuff. He said if you know where to place the steth you will better auscultate the bp. I have been trying to hear a brachial pulse with my steth but no luck. Any input?

I think your partner meant to palpate for the pulse so you know where to put the steth.

 

[jjesusfreak01]

I couldn't get a bp on a pt the other night in the back of the ambulance and asked the als person on board to try. He got one. Afterward he told me to auscultate the brachial pulse before putting on a bp cuff. He said if you know where to place the steth you will better auscultate the bp. I have been trying to hear a brachial pulse with my steth but no luck. Any input?

Sometimes you just can't get it. Every patient is different. Young healthy patients with good veins are easy most of the time. Old pts with CHF, PAD/PVD, DM, etc are going to tend to be harder. If you palpate for the pulse, put your scope over that, and still can't hear it you might just be outta luck for that patient.

 

[Icenine]

Bob Page says,

Use the bell (soft touch w/ littmann tuneable)

And keep the scope away from the cuff. Putting the bell under the cuff will do you no favors.

 

[vamike]

Yeah this PT was a 73yo male bp of 80/40. He was already in agonal breaths. Got his bp while in nursing home but couldnt in the truck. Ill try palpating for the pulse and make sure i keep the steth out from under the cuff. Thanks all.

 

[LoneStarSoldier]

If someone already said this then ignore it, but you can get a guestimated BP without a stethoscope. Just look at when the needle starts and completely stops bouncing. Subtract 5 from the start and add 10 to the end. One of my PAs taught me that and it's decently accurate

I've used this method too in a field environment. However, I think that in the field is the only situation where this method would be useful when noises and things are going on around you (like more urgent patients presenting or you not being able to stay in one spot for very long). Otherwise, if you can get an automated or manual BP with a stethescope, go for it. But you're right this is better than nothing. Even if all you can definitively say is 'The Pt. is not going into shock, and his vitals are stable' that's better than nothing.

 

[Boredderob]

Yeah, it's really late, whatever.

Float the arm by placing the patient's elbow on your knee. Put your weight on to the ball of your foot and let the patient's hand hang freely, slightly overextending the elbow. The patient's hand should be bouncing a bit against the tension as the rig moves. In my experience this works with any quality stethoscope.

Obviously, don't do this if the arm in question is injured or if the patient is restrained.