What do you mean he has another arm?

Brandon O

Brandon O

Puzzled by facies
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Anyone have any clever tips for getting BPs on the patient's RIGHT arm in the back of the rig? I have to confess it usually turns into a minor leaning-over circus for me.

Those of you riding around in boxes need not apply, "I park my butt in the other seat" does not count as a handy trick :P
 
Have you tried using the trigger grip/hand aneroid style blood pressure cuffs?
 
I wish. Those are badass.

Doesn't avoid the issue of getting the cuff on, where you park their arm, leaning over with the steth, etc. however.
 
Well, once the cuff is on, why take it off? Stand up, reach over (and have them cross their arm over their body so it's closer to you), strap it on, and have them relax. Now with the guage in the handle, you only have to reach over their body with one hand to hold the stethoscope head against their arm because you can hold the guage/handle closer to you. You still have to reach over them, but it eliminates the hovering needed to see the guage.
 
Well, I usually just clip the gauge to their chest. But you're right, that would be a little easier. But what am I going to do, buy my own cuff?

I'm usually a little wary of draping their arm across their chest, because 1) it seems like it might not stay there on its own, so they'd up end flexing their bicep, and 2) I don't want the bladder to press against their chest and bounce to 220 every time we hit a bump. But maybe I'm being anal. I usually tuck their arm straight at their side, against the railing, but that's waaay out of the way.

This is all pretty finicky but enough to make me irritated at dial patients with their fistula in the left arm.
 
I wasn't talking about keeping their arm across their chest for the entire trip. Just while you put the cuff on. Once the cuff is on, move the arm back to their side.
 
Ah, I see. That sounds reasonable.

Maybe I'll just sit on their chest. Can't imagine anyone would mind that.
 
You know, that's a great problem you posed Brandon. Often times I find myself dropping everything when I'm bumping up and down on the road trying to lean over and cuff their arm to get an accurate BP. JPINFV has some great tips though that I will make sure to use next time. The difficulty is getting the cuff on while reaching over - you don't want them to get agitated, and also the arm needs to be extended straight to get a good auscultating point.

1) You can put a pillow underneath their arm and tell them to lay it on so you can "straighten" the arm out.

2) Tell your partner to wait 30 seconds before he starts the rig so you can BP accurately without movement and shaking. (though only necessary for stable patients, as your transport shouldnt be longer then 15 minutes). Unstable patients every 5 minutes definitely requires a bp read during enroute. Getting a good arm, a good cuff, and a good steth makes the difference.
 
BP cuffs, physics and drip irrig fittings

If I put a BP cuff around your arm and pump it up it puts a nearly uniform pressure around the arm. Ideally the bladder goes over the artery, but some variance with a naked arm is tolerable. If I put a cuff around the arm, pump it up to about 90mm Hg, then squeeze over the bladder while watching the meter I will exert a very similar pressure and it will be valid. If the pt has a BP cuff on the arm and it is at his/her side, the reading should be OK if the bladder is pretty close to or right over the artery and vein being auscultated. Confounders are extreme obesity or cachexia, getting the bladder away from the vein, proximal constrictors like rolled up sleeves, and listening through clothing.

Make a longer line to your gauge using a cut-off oxygen tube and the barbed fittings you can buy for drip irrigation systems. In fact, you can make a custom stethoscope tubing that way including a learner's second line (but you still need a diaphragm/head and ear stems).
 
Put the gurney in backwards.
 
firetender said:
Put the gurney in backwards.
Click to expand...

:lol:


mycrofft said:
If I put a BP cuff around your arm and pump it up it puts a nearly uniform pressure around the arm. Ideally the bladder goes over the artery, but some variance with a naked arm is tolerable. If I put a cuff around the arm, pump it up to about 90mm Hg, then squeeze over the bladder while watching the meter I will exert a very similar pressure and it will be valid. If the pt has a BP cuff on the arm and it is at his/her side, the reading should be OK if the bladder is pretty close to or right over the artery and vein being auscultated.
Click to expand...

You're right, of course, but as I mentioned the problem isn't so much pressure on the bladder (which is okay if consistent), but the jolts in pressure you'll get if the bladder is supported and the wheels on the bus go up and down. It's hard enough getting a reading without the needle leaping up 70 ticks right as you start hearing Korotkoff.

But honestly putting the cuff on in the first place has to be half of the bother. I always seem one hand too few if they're not able to lift their own arm; the velcro starts directly underneath. What they SHOULD make is "otherhanded" cuffs where the velcro starts on the opposite side of the bladder... I'd pay for that...
 
firetender said:
Put the gurney in backwards.
Click to expand...

seems like the most logical solution.

I've actually had a few older patients who could hardly stand riding in the rear facing gurney. The option of a gurney that would allow placing in a forward facing position would be cool in some situations.
 
This is kind of off topic, but the bumps reminded me of this Pt. I had a Pt. with muscle tremors, possibly Parkinson's and everytime his arm would tremor, the gauge would go crazy. Made it very difficult to get a BP.

Anyone have any tips for that situation? Been in that situation?
 
Tremors are every assessment's best friend. Parkinson's, cold, pain, road vibrations. BP, pulses, ECG. Good times.
 
Well, I park my butt in the other seat........:P

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mycrofft's idea sounds wonderful! I am going to try that. Seems like a longer steth and cuff tubes would do it. As for outting it on, if you get it on their right arm onscene, just leave it there.
 
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