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

[usalsfyre]

It was on a ride out for class. It was an ALS transport where the patient went south on us. Patient had a fancy prostic right arm. So that means there is no left arm to take a BP on.

:huh:

You mean a prosthetic left arm?

Standing in an ambulance transporting code 3 is needlessly dangerous. Your preceptors shouldn't be asking you to do this.

 

[DesertMedic66]

:huh:

You mean a prosthetic left arm?

Standing in an ambulance transporting code 3 is needlessly dangerous. Your preceptors shouldn't be asking you to do this.

Yeah that's what I meant. My spelling is horrible. The preceptor asked me to get a BP so he could push a drug (not sure what it was). And I wasn't going to argue with him. If things don't make sence to me then I will ask. But in that case it made sence to get a BP while going code 3...... Well made sence to me.

 

[cappello91]

cool thread, thanks!

 

[Akulahawk]

You were told by an RN?

-Position the patients arm with palm up
-Straighten the arm
-Put forearm on your knee. Don't touch cot with your knee or you'll still hear background noise.

If you can't hear BP then palp.

Also try to get the arm floated off the gurney rails... Get your heels off the floor. Cradle the patient's arm in a relatively straight position. You want to minimize any vibration that can be transmitted to the arm and steth head. Hopefully you'll be able to hear the sounds even while doing 80+ on bumpy road with the sirens blaring... oh, and make sure you can palpate the brachial artery. Why? You want to center the steth head over it and in the event that you can't hear the sounds, you can easily do a palpated pressure because you know where the brachial artery is.

 

[Nimrod_BasketCase]

We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.

 

[Amycus]

We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.

While I sorta understand the logic...if my partner drove like that on an actual call, code 3, priority 1, whatever you want to call it, I'd be on the phone SO fast with my supervisor demanding he be remediated or stripped from driving his head would spin. There's no reason no matter how emergent your patient is you should EVER drive like that. I get the logic of trying to listen in bad situations, but if your instructors are giving you that scenario, it's like they are encouraging reckless driving.

 

[DesertMedic66]

While I sorta understand the logic...if my partner drove like that on an actual call, code 3, priority 1, whatever you want to call it, I'd be on the phone SO fast with my supervisor demanding he be remediated or stripped from driving his head would spin. There's no reason no matter how emergent your patient is you should EVER drive like that. I get the logic of trying to listen in bad situations, but if your instructors are giving you that scenario, it's like they are encouraging reckless driving.

If it was a class about driving then yes I could see it encouraging reckless driving. But since the focus of the lesson is on taking vitals inside a unit going code 3 then it's not really encouraging it. They are just making it as hard as possible for you do get a set of vitals. I have never been in a rig that went smoothly while going code 3. I have been in 2 situations where we could have crashed even tho the operator was doing everything correctly and legally.

 

[Akulahawk]

We practiced taking vitals in the back of the ambulance with lights, sirens, and loud music. I thought it was kinda hard I could barley hear anything plus it was a crazy ride too. They were taking sparp turns, speeding up and stoping, and going over speed bumps fast. I hope I get better at it usually when we do take vitals in the back of the ambulance it's a smooth ride and pretty quite so it's not that hard we also tell the instructors what we got then they give us something different to put on the PCR's.

Driving like that is NOT appropriate for learning to do vitals. It IS perhaps (briefly) appropriate to strap a new driver into the gurney to teach them how NOT to drive. EVER. Driving recklessly to simply learn to do vitals? Not appropriate.

 

[rhan101277]

Experience. That said, do it as much as possible in the back of a moving rig. The more you do it, the better you can pick it out.

 

[ZombieEMT]

My solution was to buy a new stethoscope, even though I could not afford it. If you run enough calls, its not really an option. If you can not hear the BP, not really a good things. I went from cheap piece of crap to a Littmann Master Classic, works like a charm.

 

[82nd medic]

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

 

[usalsfyre]

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 can't believe people admit to this stuff sometimes....

How do you account for needle bounce from movement instead of arterial pressure changes?

 

[Akulahawk]

I can't believe people admit to this stuff sometimes....

How do you account for needle bounce from movement instead of arterial pressure changes?

While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.

 

[usalsfyre]

While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.

That's what I mean. A transducer and software algorithm is able to detect and filter that stuff. A possibly miscalibrated gauge and your eyes might have a bit harder time...

 

[82nd medic]

I can't believe people admit to this stuff sometimes....

How do you account for needle bounce from movement instead of arterial pressure changes?

While that's the basic idea behind oscillometric methods of obtaining a BP, our eyes aren't sensitive enough to detect road bump vs patient flexing muscles vs arterial pressure changes.

That's what I mean. A transducer and software algorithm is able to detect and filter that stuff. A possibly miscalibrated gauge and your eyes might have a bit harder time...

Never said it was the best way to do something but it is a possibility. Needle bounce from arterial pressure change should have a pretty constant pattern unless the patient has an irregular pulse, while the other things you listed don't. Just apply some common sense and you can atleast get some idea of what the BP is... Which is better than nothing right? Do all ambulances have that equipment? If not then again: it's better than nothing.

 

[medicstudent101]

Sure, it might be better than nothing. If you're going ahead and doing a BP like that, there's no reason you shouldn't take it by palp. It's much more accurate and there's nothing useful you can really be doing with one extra hand except going for the BP over palp.

 

[ffemt8978]

Never said it was the best way to do something but it is a possibility. Needle bounce from arterial pressure change should have a pretty constant pattern unless the patient has an irregular pulse, while the other things you listed don't. Just apply some common sense and you can atleast get some idea of what the BP is... Which is better than nothing right? Do all ambulances have that equipment? If not then again: it's better than nothing.

Yeah, that will stand up pretty well when you go to administer a drug based upon a "better than nothing" BP. :wacko:

If you can't get an accurate BP, you're better off documenting that you are unable to obtain one instead of making a WAG.

 

[82nd medic]

Yeah, that will stand up pretty well when you go to administer a drug based upon a "better than nothing" BP. :wacko:

If you can't get an accurate BP, you're better off documenting that you are unable to obtain one instead of making a WAG.

I can't name a single medication that needs a BP range so close that being off by 5-10 would be a definative contraindication. Can you? Again: common sense applies, If that guestimated puts you in the clear then go for it. If it's close than don't. Either way, it's not all that more innacurate from a manual BP, especially when there are outside noises, and those are considered more than accurate enough to push meds.

 

[82nd medic]

How easy is it to read a very accurate B/P period? The only pressure you should trust to be completely accurate is off of a properly transduced a-line with a good waveform. Everything else is really some level of guess.

^^^ just to bring up what someone else already said. And yes palp is more accurate, but it doesn't give you diastolic. Hell do both, nothing says you can't use palp for establishing the systolic (which most medications, especially at the BLS level are based off of) and needle-bounce for getting as good an idea as possible for diastolic.

 

[JPINFV]

I can't name a single medication that needs a BP range so close that being off by 5-10 would be a definative contraindication. Can you? Again: common sense applies, If that guestimated puts you in the clear then go for it. If it's close than don't. Either way, it's not all that more innacurate from a manual BP, especially when there are outside noises, and those are considered more than accurate enough to push meds.

The problem is that the margin of error is already +/- 3 for most cuffs, which really works out to a +/- 6. After all, if you're first reading is 120 and the second is 126, it could always be holding steady at 123. Of course this brings us to the fact that when you round you lose an additional number to error anyways.