Vitals

[BrodyL4513]

Hey Guys and Girls,
I am new to the forums so please forgive me if I am putting this in the wrong section. I have had my New Jersey EMT cert for about 4 months now and I was wondering if I could get some tips. The hardest thing for me is obtaining vitals, specifically a blood pressure. Does anyone have any suggestions on how to get a blood pressure the first time you pump up the cuff? I know practice makes perfect but my practice is my patients. Any suggestions are welcome!

 

[Akulahawk]

Apply the cuff, palpate the brachial artery near the AC, begin inflating the cuff, eventually you'll feel the pulse disappear. Inflate about 20-30 mmHg past that point, put the stethoscope head right where you palpated that pulse, and slowly deflate the cuff. The first sound you hear is the SBP, last sound you hear is the DBP. The key thing is to palpate the brachial artery and not the radial artery when you do this. That palpation will help you figure out exactly where to put the stethoscope head so you won't miss that first sound.

 

[Medic Tim]

Apply the cuff, palpate the brachial artery near the AC, begin inflating the cuff, eventually you'll feel the pulse disappear. Inflate about 20-30 mmHg past that point, put the stethoscope head right where you palpated that pulse, and slowly deflate the cuff. The first sound you hear is the SBP, last sound you hear is the DBP. The key thing is to palpate the brachial artery and not the radial artery when you do this. That palpation will help you figure out exactly where to put the stethoscope head so you won't miss that first sound.

This is how I learned to take a bp in nursing school.

 

[STXmedic]

I just press the button...



Or what akula said

 

[BrodyL4513]

I just press the button...



Or what akula said

Haha not all of us can be so lucky

 

[OnceAnEMT]

As you said, practice makes perfect It can be difficult. Helps to have a stethoscope that is worth a damn, especially when on the truck.

BP you get used to as you experience more Pts. Its resps that I struggle with half the time. There's just some people that just, don't move. No O2 mask on to watch fog, no body moving, slow and steady enough to where nostrils don't flare. Means there resps aren't a problem, but you still need a number. I find myself asking to listen to there lungs for a few seconds, or taking a pulse across their chest.

 

[JPINFV]

BP you get used to as you experience more Pts. Its resps that I struggle with half the time. There's just some people that just, don't move. No O2 mask on to watch fog, no body moving, slow and steady enough to where nostrils don't flare. Means there resps aren't a problem, but you still need a number. I find myself asking to listen to there lungs for a few seconds, or taking a pulse across their chest.

You can always "listen to their heart" and count breaths instead.

 

[TransportJockey]

As you said, practice makes perfect It can be difficult. Helps to have a stethoscope that is worth a damn, especially when on the truck.

BP you get used to as you experience more Pts. Its resps that I struggle with half the time. There's just some people that just, don't move. No O2 mask on to watch fog, no body moving, slow and steady enough to where nostrils don't flare. Means there resps aren't a problem, but you still need a number. I find myself asking to listen to there lungs for a few seconds, or taking a pulse across their chest.

I put them on a capno canula

 

[mycrofft]

When you place the diaphragm of the steth on the antecube, instead of holding the forearm with the palm up, turn the forearm over so the hand droops. This allows the tendons and muscles to relax better so you get a closer approximation to the vessels. (Same for palpating a radial pulse, droop the hand down).

Is that understandable? :unsure:

 

[teedubbyaw]

I don't really agree with palpating a brachial. It's easier to use radial if you want to get a quick baseline, IMO.

A lot of what I see from new people (and I did it, too), is not extending the pt's arm. Bring is straight out and hold it it rest it on your leg.

 

[DesertMedic66]

I don't really agree with palpating a brachial. It's easier to use radial if you want to get a quick baseline, IMO.

A lot of what I see from new people (and I did it, too), is not extending the pt's arm. Bring is straight out and hold it it rest it on your leg.

Your palpating the brachial so you know where to place the steth to get the best sound. Your not going to take a palpated pressure from there.

 

[Handsome Robb]

I just press the button...



Or what akula said

bahahaha its sad but it is true a lot of the time.

 

[mycrofft]

At least no one has suggested a central line ..so far.:unsure:

 

[JPINFV]

At least no one has suggested a central line ..so far.:unsure:

Because CVP is terrible at estimating fluid status and you get a BP off of an A line.

 

[teedubbyaw]

Your palpating the brachial so you know where to place the steth to get the best sound. Your not going to take a palpated pressure from there.

That's not what hawk described. And I'm aware of both methods.

 

[STXmedic]

That's not what hawk described. And I'm aware of both methods.

Umm... Akula was describing how to take an auscultated, like desert said... So yes, that is what he described...

 

[mycrofft]

Some pts, going brachial is going to be a challenge in itself because of adipose tissue and necessity of using a wide cuff.

Not just a few new EMT or nursing students describe a dry period early on when they have trouble getting BPs. Practice and work through it. Get backstopped by co-workers.

 

[Akulahawk]

Umm... Akula was describing how to take an auscultated, like desert said... So yes, that is what he described...

Yep, that's exactly what I was describing. Now if I was going to palpate a BP, I'm going to forget using the brachial, I'll use the radial if it's present and palpable. I'm also going to extend the elbow as much as possible if I'm going to attempt auscultation.

Another reason why I'm going to palpate the brachial artery right at the AC is that it gives me an idea if I'm going to even be able to hear it. It also allows me an excellent chance to assess skin signs up in a little more detail. Usually by the time I'm slapping on a BP cuff, I've already palpated a radial pulse, gotten a rough idea of the pulse rate (fast/slow), in essence, I have an idea of the acuity level of this patient even before I've gotten around to taking a BP. Those few times I actually had an autocuff, I'd just slap it on, push a button (delegating the task to the machine), attach the SpO2 probe, and I'm on to doing other assessment and immediate treatment stuff.

How long should it take for me to get to this point? If I have to move fast, less than 30 seconds... doing the BP manually takes maybe another 30 seconds.

 

[Drax]

1. Put the cuff on patient
2. Blow it up to 160-170
3. Put on stethoscope
4. Apply pressure to the tunable diaphragm on the brachial artery (jam that sucker into the inner elbow) while their arm is fully extended
5. Auscultate
6. If you hear nothing, release the valve at a slightly faster rate than normal and pump back up (you're listening for a systolic if you didn't hear one before)
7. If you can hear it, pump more
8. Locate at what point you first hear it (silence turns to beats)
9. Slowly release valve
10. Locate at what point you can't hear it (beats turn to silence)

Viola.

 

[STXmedic]

Don't jam the diaphragm anywhere. Putting pressure on the bell will skew your diastolic reading.