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

JPINFV said:
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.
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No argument here, luckily BP is just a guideline not an absolute
 
IrightI said:
My vote is for a Littman Master Cardiology B)
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And what are they going to do when their Master Cardio breaks/vanishes/is hit by a meteorite?

Practice, practice, practice. You'll get it.
 
make sure the PT is not resting arm the stretcher in the rig. put it on your leg or suport it with your arm to eliminate a lot of artifact
 
rest the patients arm or elbow on your knee, and get your heel off the floor (so you're toe is on the floor but you're still sitting), this allows bumps in the road and what not to somewhat be dampened. It's a trick someone showed me once, you could try it and decide for yourself if it really works.
 
To better hear in a moving rig, put your feet up on the cot. Sound is nothing more that vibrations. By putting your feet on the cot, (they only need to be on legs of the cot not on the PT or anything like that) you are putting a barrier between you and the floor of the ambulance. The cot will absorb a ton of vibrations. A little trick my instructor learned at the Wisconsin EMS Association Conference that he passed along to us. I tried it and it makes a world of difference. The other thing you could do is use an automated BP cuff. ;)
 
I thought this was funny I actually had a student I was training do the exact same thing....Just for fun I told her to do it again and she still gave me an odd number.....People are funny sometimes because they thing when they don't know how to do something they can just bs their way out of it....This may be true in other lines of work but in EMS you will most likely get your hand called..... But still quite funny .
 
HotelCo said:
How are you going to know if you hear it "incorrectly"? ;)

Side note: Once had a partner tell me the pt's BP was 64/93. I asked if he mean 93/64, and he was convinced that not only could he hear the bottom number first, but that he could read between the lines on the BP cuff.
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Do tell how he passed his state test lol
 
Along with the resting your feet on the gurney/resting pt's elbow on knee, I like to hold my bell against their arm with the palm of my hand or the meaty part of my thumb. It may just be me but I guess I've got squeaky joints and every time my fingers move i hear a bunch of noise through my scope :sad:
 
The last post works as long as you have a single bell. If you have a 2 sided bell you may actually hear your own heart.
 
Keep in mind if you're cupping your hand over the steth, some scopes, like my Ultrascope, are pressure sensitive. Push too hard and you will hear NOTHING at all
 
Some of the have probably already been mentioned, but...

Sometimes the best trick is to time your BP assessment with a stop at a traffic light. If you absolutely need to auscultate a BP (i.e. you don't want a palpated BP) and you cannot hear it, the best thing to do would be to have the person driving pull over. Also it is always helpful to palpate the location of the brachial artery before measuring the BP.

Or, maybe I can track down the EMT that was able to palpate a diastolic pressure (insert facepalm here) and he can fill us in on his "trick".
 
2 cents

i found that if i pick my heels off of floor of rig it cuts down on noise
 
It mostly take lots of practice. You get where you know what you are listening for and you can pick it out.
 
EMSslick536 said:
Haha, yea that's what they told us at CFR class.. If you get a odd number reading.. you probably need more help than the pt. sitting in front of you. haha :)
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Why? I can get odd numbers all the time. If I hear the korotkoff sounds while the needle is between the lines, then it's an odd number. The sounds don't always come when the needle is directly over a line. Besides, taking a blood pressure is hardly an exact science. Take a 100 practitioners and you'll get 100 different BPs, but they'll be pretty close.
 
I try to get a manual baseline before we go, after that it's up to the LifePack to check BP for me.
As far as a manual pressure in a moving ambulance, I think a good scope and practice is the answer.
 
Baseline Vital Signs

phideux said:
I try to get a manual baseline before we go.
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Exactly right. In addition to the aforementioned (raise your heels or put your feet on the gurney and rest the patient's arm on your knees - which really does help by the way), you always need to have a baseline blood pressure. Never leave a scene without a set of vital signs, with the one exception of patients in extremis (and even that is only really applicable to BLS providers). If for no other reason, and there are plenty, it will give you a good idea of where to expect your Korotkoff sounds. I also make a habit of both auscultating first and palpating second while transporting (in order to confirm the systolic reading).
 
A good stethoscope and practice.
 
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?
 
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