Question on BPs

[AnthonyM83]

In my EMT class, I learned to palpate systolic first or palpate as your BP cuff inflates to get a rough estimate of when the pulse goes away, then when auscultating listen about 30 mmHg above that.

Logic? There are some gaps where there is no sound and if you stop inflating during one of those gaps, you might think the first sound after you deflate is your systolic, but in reality if you had kept inflating the sound would have come back, then disappeared a second time....THEN you could start deflating and when you hear the beat THAT is your systolic.

Usually there isn't a gap (of silence), but every now and then there is, so palpating first (or while you inflate cuff) gives you an estimate of ausculated systolic (because there are no gaps when palpated). So instead of systolic of 130, it might have really been 180, but you missed it because you started deflating at 160ish and just picked the first sound you heard.

At least that's what I was taught . . . and just today we were talking about BPs with some coworkers and they had never heard of this. Have you guys? Was my BP skills instructor just nuts? (very likely...I'd just like to know)

[mobey]

I was taught quite the opposite.

I was told that you should not take consecutive BP's off the same arm because applying a constrictive device to the arm messes the pressure within that limb, leaving you with a less than accurate second BP.

I will try to hunt down some science to back this theory up, or discount it.

[AnthonyM83]

That makes sense actually. It can cause venous congestion. How about the the theory of palpating on the way up to get an estimate of true systolic due to "silent gaps" on the way down.

And while I'm on the topic.... What's the verdict on taking BP's on the same side as an IV? I've been it's preferred to use opposite arm, but if it's hard to get to using same arm as IV is still accurate and not harmful...but I've also read the opposite.

[CBEMT]

If you're working with me I'd prefer you clamp the IV first, but other than that if the arm has to be used than so be it.

[dougd]

I was taught to palp as you inflate the BP cuff and then listen 30mm/Hg above that in basic school, too. Of course, I was also told right after, "and that's what the book says... tell me if you ever actually do this in the rear world in the back of a squad."

[under-dreaming]

I am still new to the profession. I often times just pump it up to 200mm/Hg and go from there. Or, if it is a medical call, many people actually know their usual blood pressure, just go 30mm/Hg above that. During my first ride out, the paramedic who was watching over me had me take a B/P on someone who had an IV in their arm about two inches distal to the anterior portion of the elbow. I was actually able to hear the B/P through all of the tape holding the IV in place.

There isn't a lot of options for us in the back of the rig when it comes down to retaking B/P after a failed attempt. It might be a little off, but not so much that you could miss a life threatening condition. And remember: Treat the patient, not the machines.

-Kiel

[AnthonyM83]

So, no one else has heard of the idea that when deflating the cuff at high BP's, the sound might initially go away, then come back?

[Richard B the EMT]

Under-dreaming indicated being new to our profession, and just pumps up to 200 MM/Hg. I'll presume that is due to training received. Per mine, I just go to 180, and start dropping the pressure. If I hear the pulse at 180, then I go to 200, and already know someone is not gonna like being told they aren't in good health. Even worse if the diastolic is anything above 100.

[Eydawn]

I've been taught it both ways. My initial training was to pump it up to the 180-200 range and slowly deflate, listening until the needle hit zero.

My refresher course instructor made me palpate the pulse, inflate until it disappeared, and then inflate 20mmHg above that point... then deflate and listen all the way to zero.

I haven't seen it make a difference, tbh... I know if I was in a hurry, it'd be the old stand-by.

So how do the electric ones used in the hospital setting work? Are they sensing that the pulse disappears and inflating past that? Or are they pre-set to inflate to a certain pressure?

Wendy

CO EMT-B

[Richard B the EMT]

I could be wrong, but they probably go to a pre-set. I have also seen the automatics reach the pre-set pressure, and almost do a doubletake, and pump up a bit more, usually on patients I already did "manually" that had way elevated BPs.