Why do we trust Auto-NIBP?

[18G]

How about this, anybody got some studies that describe the clinical accuracy of NIBPs?

I did a search to try and find some studies that compared the two methods but came up empty.

 

[usalsfyre]

I personally believe anyone who doesn't take a manual BP first is just lazy, honestly.

Guess I'm lazy.

It takes a minute, and it gives you something to compare to the NIBP.

If they don't mesh, which one do you use? Because the cuffs we typically use aren't noted for their accuracy. [1] [2] (yes they're old articles, but do you think the treatment of the equipment has changed?) Nor do I typically see EMS units have multiple common sizes of aneroid manometer in the first in bag. I have everything from "thigh" down to "neonate" for my automated BP in the monitor.

Yeah, you trust it but it only takes one time for it to be incredibly off in an emergency to possibly harm your patients and bite you in the bum.

Agreed, but I've seen this as often with manually taken pressures.

I think the "I'm better than a machine" attitude is ego and distrust of technology talking. Does anyone here doubt ETCO2? I also think there's some concern over devaluing some providers as the thinking may be that a machine can do a portion of their job.


[1]Jeffrey S. Jones MD, William Ramsey MD, and Thomas Hetrick MD, FACEP "Accuracy of prehospital sphygmomanometers " Journal of Emergency Medicine 5, 1 (1987) p. 23-27

[2]Décio Mion Jr, Angela M. G. Pierin, Débora Cristina Alavarce, José Henrique and Cunha Vasconcellos "The Results of the Campaign for Evaluating Sphygmomanometers Accuracy and their Physical Conditions" Arquivos Brasileiros de Cardiologia 74, 1, (2000),

 

[Sasha]

I guess you are lazy, and I have no qualms about telling you that.

I trust my own ears a heck of a lot better than I trust a machine in a bumpy ambulance that gets abused on a daily basis and probably doesn't get calibrated as often as it's supposed to be. I know which partners to trust taking a BP and which one makes up numbers.

 

[usalsfyre]

I guess you are lazy, and I have no qualms about telling you that.

I trust my own ears a heck of a lot better than I trust a machine in a bumpy ambulance that gets abused on a daily basis and probably doesn't get calibrated as often as it's supposed to be. I know which partners to trust taking a BP and which one makes up numbers.

So your sphygmomanometers get calibrated regularly? Otherwise those instruments are just as likely to be wrong.

 

[SeeNoMore]

I think using both is clearly the best option, as is getting a blood pressure on scene before you are moving around in the ambulance. I did find a study that noted EMS personell took a high ammount of incorrect b/ps in a moving ambulance but I can't find where I saved the link, I'll repost it.

I think it's also important to have a degree of humility. If you can hear the bp well, great. If you are unsure, you should palp, use the auto cuff, asesse the pt and figure out what is going on. I normally do fine, but there have bene some patients that I had a hard time with once in the ambulance with sirens blaring.

 

[18G]

I know of several BLS companies in my area that carry dopplers for difficult to hear blood pressures. Anyone else carry these?

 

[SeeNoMore]

No I read about them in my textbook but kind of thought it was one of those pieces of EMS tech that did not really get put on ambulances. I have never encountered one.

But I am also in PA....so maybe I am just not aware of what is going on!

 

[8jimi8]

My Doppler is pulse quality.

 

[Bieber]

I personally believe anyone who doesn't take a manual BP first is just lazy, honestly. It takes a minute, and it gives you something to compare to the NIBP. Yeah, you trust it but it only takes one time for it to be incredibly off in an emergency to possibly harm your patients and bite you in the bum.

Let me ask you this, if the contention is that NIBPs are inaccurate only due to the movement of the truck, then using the NIBP on scene should be just as good as the manual, right? In which case, you can use that initial NIBP to use as a measure of accuracy for all subsequent NIBPs, right?

I did a search to try and find some studies that compared the two methods but came up empty.

Likewise.

[1]Jeffrey S. Jones MD, William Ramsey MD, and Thomas Hetrick MD, FACEP "Accuracy of prehospital sphygmomanometers " Journal of Emergency Medicine 5, 1 (1987) p. 23-27

[2]Décio Mion Jr, Angela M. G. Pierin, Débora Cristina Alavarce, José Henrique and Cunha Vasconcellos "The Results of the Campaign for Evaluating Sphygmomanometers Accuracy and their Physical Conditions" Arquivos Brasileiros de Cardiologia 74, 1, (2000),

Thanks! I'll take a look at those in a second.

 

[Hockey]

Always get a manual first. If I have time and feel like messing around I'll throw the auto on the right arm, as I am doing a manual on the left arm.

I know of several BLS companies in my area that carry dopplers for difficult to hear blood pressures. Anyone else carry these?

Hah! I've never seen a Doppler nor would I know how to use them.

I'm up for some educating, what do you do while using it?

 

[bigbaldguy]

I know of several BLS companies in my area that carry dopplers for difficult to hear blood pressures. Anyone else carry these?

Is a Doppler that little shiny salt shaker that Doctor McCoy would wave over people on Star Trek

 

[mcdonl]

I suppose there is always that possibility. However, on a personal level, I'm fairly confident in my ability to take an accurate blood pressure, as it is a skill I use (virtually) daily. With that being said, I generally find that my results are on par with the auto-NIBP.

For me, I use the auto cuff when I get a reading that is way out of the norm and I just want a second opinion.

 

[HotelCo]

We shouldn't trust the NIBP? What's next, we shouldn't trust the machine's interpretation of an EKG?

 

[firetender]

We shouldn't trust the NIBP? What's next, we shouldn't trust the machine's interpretation of an EKG?

The point I'm getting here is tighten your own ability to manually or visually ascertain the progression or deterioration of your patient so that you can pick up on it if your machines are failing you.

Machines fail. If you blindly follow them, so will you. Remember, a machine is YOUR tool, not the other way around.

I learned this on my very first call as an "attendant". The machines worked, I didn't, the patient died. I'll tell the story if anyone's interested.

 

[Sunyata]

I was always taught to treat the symptoms, not the numbers...

That being said, I usually will take a baseline manual BP before hooking up to the NiBP. I have never found there to be a discernible difference between my reading and the auto reading, though.