Pulse Oximeters and BP

[CBEMT]

http://www.jems.com/news_and_articles/tips...ers_and_BP.html

Personally, I'm speechless. I tried to comment, but just couldn't find the words.

[Dustdevil]

I'm with you. I don't even know where to start. But I'll try.

What exactly does hearing loss have to do with an inability to competently check a pulse? :?

[VentMedic]

Masimo in "trauma mode" comes the closest to restoring a pleth in poor perfusion states after a BP but even that has a delay.

The transducers on A-lines don't always immediately establish a pleth if someone does a BP on that arm.

A Comparison of the Failure Times of Pulse Oximeters During Blood Pressure Cuff-Induced Hypoperfusion in Volunteers

http://www.anesthesia-analgesia.org/cgi/co...t/full/99/3/793

[p3medic]

It certainly lacks accuracey however in a noise filled environment, helicopter, construction sight, machinery running etc.. it does work in a pinch for a ball-park estimate of systolic bp.

[AnthonyM83]

I was going to post about this same thing.

I mean, I understand the concept...it might be hard to even palp it on a bumpy road....but it doesn't seem very scientific...

[JakeEMTP]

How does he check for a pulse? Oh wait, that's what the Pulse Ox is for :roll: . If you can check a pulse, one should be able to obtain a BP by palpation. I'm confuzzled.

[p3medic]

Use of Pulse Oximeter for determination of systolic blood pressure in a helicopter air ambulance, Air Medical Journal, 4:149, 1998

Assessing oxygenation in the transport environment, Air Medical Journal, 18(2):79, 1999

[MSDeltaFlt]

This sounds like a stretch because there is not enough information here. Is he completely deaf or hearing impaired? If he can hear enough to work in EMS on a 911 truck, then there are amplified stethescopes out there that should help out fine. I have a Littmann that can also record breath sounds. I use it to record breath sounds for RT/EMS/nursing students that have a hard time learning different breath sounds. I also use it to auscultate difficult BP's at altitude. It gets pretty loud. I like it.

[sevenball]

it doesn't seem all that off base to me. I've often used the pressure by pulse method. I've been doing this long enough to know a "ballpark" number for systolic pressures, just by feeling the strength of the pulse.

If your good enough, and practice enough, perhaps you could get good at ballparking the pressure off the pulse ox. HOWEVER! we have all been taught not to trust our equipment, but to treat our pt.'s and trust our guts, so I believe that this practice is dangerous.

Furthermore, if this guy can't hear a blood pressure, I'd hate to see him differentiate between failure and pneumonia.

[EMS49393]

What does this paramedic do when he has a patient that may have a head injury, CVA, or cardiac tamponade? Those are just three instances when a provider should be able to accurately asculate both a systolic and diastolic blood pressure. Personally, I have never had much difficulty obtaining an accurate blood pressure, so I can not put myself in the shoes of the author.

Perhaps the more experienced forum members can explain another way of determining cerebral perfusion pressure when you don't have the luxury of being able to obtain an accurate blood pressure.

Incidently, my paramedic instructor used to make us take blood pressures in class with Motley Crue (at blood curdling volume) in the background. He was very insistent that we be able to obtain a blood pressure even in a noisy arena. I'd had the same Littmann Cardiology III stethoscope for eight years or so and I used it during class. The ear pieces are soft and conform to the shape of my ears very well and act to block out most outside noise. In terms of assessing patients, it was a good investment.