What is the easiest method to learning BP?

[VCEMT]

So a 1 year-olds BP should be 101 and a 80 year-olds BP should be 180? No. Not at all.

Why would anyone take a BP on 1 year-old?

I learned to take BPs from my mom, fifteen or sixteen years ago. Borrow a BP cuff and stethoscope and go meet some women. You have to get used to coming in contact with people and attractive women. Attractive women find themselves in the back of an ambulance, as patients, at some time or another. You have to feel comfortable and not end up on a review panel for sexual harassment. I've known quite a few people to lose their licenses because, that was the first female they ever touched. Seriously, no joke. Get out their and do some.

 

[Scout]

Why would anyone take a BP on 1 year-old?...
Borrow a BP cuff and stethoscope and go meet some women....
You have to feel comfortable

Well to get a complete set of vitals? Why do you think they make cuffs for them if they are not needed?

Now there is an idea,

And i have to say there is a big difference between meeting attractive women in a social setting vs in the back of your amb.

 

[Level1pedstech]

Why would anyone take a BP on 1 year-old?

I learned to take BPs from my mom, fifteen or sixteen years ago. Borrow a BP cuff and stethoscope and go meet some women. You have to get used to coming in contact with people and attractive women. Attractive women find themselves in the back of an ambulance, as patients, at some time or another. You have to feel comfortable and not end up on a review panel for sexual harassment. I've known quite a few people to lose their licenses because, that was the first female they ever touched. Seriously, no joke. Get out their and do some.

We were also taught that a BP on a child under two was not only difficult to obtain using the manual method but results were not reliable and that good peripheral perfusion (capillary refill) is an adequate indicator of acceptable blood pressure in the under two year old patient. Im sure some one will say otherwise but for the basic I think its a good theory,wasting time trying to get a good manual pressure on an uncooperative child will only delay your initial assessment and subsequent treatment. As a peds tech I have done vitals on hundreds of kids and its seldom easy and for a new provider it can be very intimidating. Sick not sick,Cap refill,skin.pulse,resps and a temp are going to give you the information you need to get your treatment plan going.

 

[Ridryder911]

We were also taught that a BP on a child under two was not only difficult to obtain using the manual method but results were not reliable and that good peripheral perfusion (capillary refill) is an adequate indicator of acceptable blood pressure in the under two year old patient. Im sure some one will say otherwise but for the basic I think its a good theory,wasting time trying to get a good manual pressure on an uncooperative child will only delay your initial assessment and subsequent treatment. As a peds tech I have done vitals on hundreds of kids and its seldom easy and for a new provider it can be very intimidating. Sick not sick,Cap refill,skin.pulse,resps and a temp are going to give you the information you need to get your treatment plan going.

Tell to that to the Court of Law and where you can cite that a blood pressure is not needed. I believe vital signs are named for a reason. I agree if the patient is unstable not to play around to make matters worse and one has to use good common sense but be able to back up statements.

R/r 911

 

[el Murpharino]

We were also taught...

Famous last words.

I guess there is no standardization of EMS education even at the most basic level of one of the most fundamental skills.

 

[Ridryder911]

Famous last words.

I guess there is no standardization of EMS education even at the most basic level of one of the most fundamental skills.

Actually there is, unfortunately there is NO standardization of EMS Instructors such as requiring them to be educated and knowing what the hell they are talking about.

R/r 911

 

[Level1pedstech]

Tell to that to the Court of Law and where you can cite that a blood pressure is not needed. I believe vital signs are named for a reason. I agree if the patient is unstable not to play around to make matters worse and one has to use good common sense but be able to back up statements.

R/r 911

I never said that a BP was not needed or that we were taught not to document a pressure on the less than two year old peds patient. To be honest when I explained this to the RN's in the peds ED when I started as a tech they were as you could imagine a bit skeptical of the practice. But knowing the inexperience most basics have in dealing with peds they could see the point. If I could not obtain a manual BP (on any patient) I would for sure have one off the lifepak before ALS did their transport. I don't know of many medics that will take the time to obtain a manual pressure on a patient under two or any patient for that matter when they have the ability to use their lifepak. I'm sure someone will tell me otherwise and that's great but in my ED we will gladly accept either, I just wanted to point out that at the basic level adequate peripheral perfusion for your initial assessment can be determined by cap refill and further time should not be wasted by an inexperienced provider trying to get a pressure that may not be reliable after all the effort and could further delay needed treatment. Am I right or am I missing something? I can tell you if any crew showed up at our peds ED without a full set of post scene vitals there would be some butt chewing by the charge RN.

As far as things go with our litigious society. I can tell you that in the ER my trauma documentation is much more involved than my charting as a provider in the field and with my facility being a large juicy target for ambulance chasers I am always trying to improve my recording. There are times where we defer pressures during the initial assessment but only after trying every available option. That would be the only time where I would document vitals without a pressure. Fortunately the TRN and I always check the chart for accuracy before it is broken down and sent off with the patient. We all know the need for clear precise documentation but sadly its something we could all probably improve on at some level.

 

[Shishkabob]

Why would anyone take a BP on 1 year-old?

You obviously missed the entire point of that post.

 

[mycrofft]

well.......

:deadhorse:

 

[kymtgpro]

When I took my basic class we were taught that method by one of the two instructors but it was 100 for a male and 90 for a female. I do believe its an old school thing, this was a medic with twenty years of good inner city street time. He was quick to point out that all patients are different and you really have to look at all the information you have available. I would feel more comfortable with a new basic using 120/80 as a point of reference but in the real world there is no "normal" pressure. Quick example of how the above theory is flawed, I am 47 if my systolic rises above 140 the DOT can refuse to issue me a two year medical card for work.

On taking at least one manual pressure before using any automatic equipment I have to really question the benefit. I'm sure someone has some thoughts on the subject but to me it sounds like the instruction the OP was given on how to figure a patients "normal" pressure. Maybe a little old school but any further information will be considered and appreciated We use auto equipment throughout the hospital and I rarely ever see manual pressures taken. Does this mean its okay,no but if its good enough for the many professionals that use the method I think I can say with 99% certainty that we can trust the automatic equipment. Of course one must keep the big picture in mind and remember we treat patients not numbers but just reading how some folks are being taught makes me feel like it until they get some experience I would prefer an auto pressure if a patients BP is going to be playing a huge part in their treatment. I know most basics don't have access to auto equipment and they need to master the skill of obtaining manual pressures. I will be the first to point out that I have become very reliant on our monitors and robo nurses in the ER. I rarely work in the field anymore and I could stand to take a few manuals once in a while.

When I work in a hospital setting, I put total trust into auto cuffs. No one uses manual cuffs in the hospital. But when Im riding in the back with a pt, i always use manual. The vibrations from the ride tend to offset an accurate reading. Granted, it can be difficult to hear the pulse at times. Taking BP manually just gives me that warm fuzzy feeling because I have heard it for myself.

There are times when I use an auto cuff on the truck though. Every now and then we take a dialysis pt to and from a clinic. Before her appointment her BP is usually 80/60, after dialysis its commonly 60/40. It can be very difficult to hear even if taken while parked.

 

[exodus]

So we have an EMT lecturing RN's.... lolll

 

[AKStuart]

So we have an EMT lecturing RN's.... lolll

The Internet is a wonderful place, haha^_^

 

[ZVNEMT]

oh yeah, and this is justmy personal opinion......I NEVER trust NIBP (non-invasive blood presure) machines....always take at lest one manual BP and a manual pulse..... I say this becouse I know plenty of people that belive they are the best thing since sliced bread......

I'd have to agree... i once had a machine give me some crazy bp around 200/150 or something like that... after the panic subsided i got a manual bp that was pretty close to ideal.... i felt kinda dumb

 

[Foxbat]

If the hand on the manometer starts oscillating 10-20 mm above the first Korotkoff sound, does it mean that BP is not being measured correctly?

 

[Level1pedstech]

So we have an EMT lecturing RN's.... lolll

You have not spent much time in the emergency room setting have you now. I have spent countless hours "lecturing" RN's especially new graduates that come into the ED with zero knowledge of outside EMS. Do you think they come out of school knowing anything? Except for the little bit of knowledge they get during their ER clinicals or orientation most RN's have very little training in field skills and are surprised to learn what we actually can do for patients as EMT B's and P's. You might be surprised to know that I sometimes on occasion have "lectured" PA's and MD's bet that's a shock. The education or "lecturing" is non stop for all involved in the ER setting and provider level should never become a barrier to the sharing of information.

 

[Level1pedstech]

The Internet is a wonderful place, haha^_^

Nice first post. Welcome to the board

 

[Akulahawk]

You have not spent much time in the emergency room setting have you now. I have spent countless hours "lecturing" RN's especially new graduates that come into the ED with zero knowledge of outside EMS. Do you think they come out of school knowing anything? Except for the little bit of knowledge they get during their ER clinicals or orientation most RN's have very little training in field skills and are surprised to learn what we actually can do for patients as EMT B's and P's. You might be surprised to know that I sometimes on occasion have "lectured" PA's and MD's bet that's a shock. The education or "lecturing" is non stop for all involved in the ER setting and provider level should never become a barrier to the sharing of information.

Most RN's that I've met that haven't done ER for any real length of time don't have a clue what field providers can do or know. They're not exposed to the pre-hospital field during their training and don't know or realize how much of a difference there is between the various levels of EMS providers. They really don't know if the person there to take report on a patient about to be transported is an EMT or a Paramedic, and they're likely most exposed to EMT's. Given that experience, I've found that over time, they start treating all transport providers as if they're knuckle draggers.

I'm not knocking RN's by any stretch... it's just that they don't normally get a lot of contact with field personnel and what they usually do get is the lowest educated of us. It's kind of like us field personnel don't get much contact with hospital RN's and we don't know what they can do or what their skills are.

I've given and taken report to Nurses of all aptitudes and attitudes. Most are great people and good clinicians. Some... well, they're about as smart as a post and have attitude to match. I've met a bunch of field types that do the same thing...

 

[mcdonl]

Good info!

The vibrations from the ride tend to offset an accurate reading. Granted, it can be difficult to hear the pulse at times. Taking BP manually just gives me that warm fuzzy feeling because I have heard it for myself.

For this new guy, that made this thread worth it.

 

[Level1pedstech]

Most RN's that I've met that haven't done ER for any real length of time don't have a clue what field providers can do or know. They're not exposed to the pre-hospital field during their training and don't know or realize how much of a difference there is between the various levels of EMS providers. They really don't know if the person there to take report on a patient about to be transported is an EMT or a Paramedic, and they're likely most exposed to EMT's. Given that experience, I've found that over time, they start treating all transport providers as if they're knuckle draggers.

I'm not knocking RN's by any stretch... it's just that they don't normally get a lot of contact with field personnel and what they usually do get is the lowest educated of us. It's kind of like us field personnel don't get much contact with hospital RN's and we don't know what they can do or what their skills are.

I've given and taken report to Nurses of all aptitudes and attitudes. Most are great people and good clinicians. Some... well, they're about as smart as a post and have attitude to match. I've met a bunch of field types that do the same thing...

You are spot on with your observations. I think its important to point out that people that work in the ER for the most part are there because like all of us they have an interest in emergency medicine. Most ER RN spots are very competitive and I have never met an RN that choose the ER because that's all they could get or were put into the position against their will. It may happen in other areas but I highly doubt it.

We share the common goal of providing top notch care to our patients but sometimes have different ideas on how to reach that goal. Over the last few years I have tried to stay completely neutral in my views and have worked to improve the relationship between field providers and the ER staff but all it takes is one yahoo on either end and we go back to square one.