Hey all, new to the forums so i thought i'd start with a question from a recent call. I'm an emt-b and work for a private so really all calls are routine transfers (also a 2nd tier medic student so i always do a full exam if for no other reason to stay in practice). We were called to a hospital to transfer a 79 y/o male from the floor back to his nursing home. Finally found his nurse and she said pt was non-verbal and mostly flaccid (in fact the only movement i witnessed was his eyes and occasionally his head when he coughed). She took a final set of vitals and bp was high ... 213 systolic right, 188 left. I asked her to call the nursing home because i was afraid they would send pt right back and since weather was cold and rainy i didn't want pt out in it more than necessary. They were ok with it but Dr. wanted to give 0.1 Clonidine via G-tube before transport. Last semester on one of my clinicals the RN's were telling me about unequal bp's being a sign of artery obstruction. Is this not really a concern? No one other than me acknowledged they were unequal.
unequal bp's
- Thread starter nsom9ac
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I had a pt once (transport, not 911) who presented with a BP of about 90/30. When we informed the nurse, she said "Oh, don't worry, he's post CVA, check his other arm." Sure enough, he had a BP in the other arm of about 120/60. Apparently, stroke can affect BP in opposite arms. My medic didn't even know that.
Was your pt post CVA? Maybe that's why nobody seemed concerned.
Was your pt post CVA? Maybe that's why nobody seemed concerned.
I think probably so. That could explain I suppose, even though he was high instead of low. But even so, this nurse seemed like she was just trying to get rid of the patient. The only reason she took the 2nd bp was because she was afraid we wouldn't transport with 213 sys so wanted to try and get one low enough that we would transport the guy. Since my original post i've found that you have to go with the higher one in cases like this and like i said that wasn't her intent at all. But that is very good to know about the post CVA pressures.
Ridryder911
EMS Guru
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Differential blood pressures can be caused by several factors.
Remember, where arteries are branched from to get the b/p. As well, aneurysms and even positions can change B/P up to 10 points.
The differential in CVA is usually caused by hemiparesis and this causes decreased lymphatic flow as well as decreased circulation. (This is why as well, no IV's or veinapuncture should be started on affected extremity).
R/r 911
Remember, where arteries are branched from to get the b/p. As well, aneurysms and even positions can change B/P up to 10 points.
The differential in CVA is usually caused by hemiparesis and this causes decreased lymphatic flow as well as decreased circulation. (This is why as well, no IV's or veinapuncture should be started on affected extremity).
R/r 911
Oh ok, during my clinicals last semester i was told specifically not to start an iv on a specific side on some patients, but unless they had a dialysis port on that side i didn't get an explanation of why. Thanks, it's all giving me a much bigger picture of it all.