BushyFromOz Posted August 12, 2011 Share Posted August 12, 2011 Yeah, that's what I've been told to...but I've never heard anyone justify this as a physio marker for AAA... I'm not saying that it's not good for anything, I just have no idea what in fact it might be for...people love to say, (Not meaning you Happiness) "Be sure to get a b/p on both arms!" I wanna say that! I just have no idea when to do it! Dwayne i sort suspect its like pub ammo - an interesting random fact that you dont really have a need for or a way to use it making it essentially useless most of the time Link to comment Share on other sites More sharing options...
DFIB Posted August 12, 2011 Share Posted August 12, 2011 Yeah, that's what I've been told to...but I've never heard anyone justify this as a physio marker for AAA... I'm not saying that it's not good for anything, I just have no idea what in fact it might be for...people love to say, (Not meaning you Happiness) "Be sure to get a b/p on both arms!" I wanna say that! I just have no idea when to do it! Dwayne "A patient with dissecting aortic aneurysm may also exhibit difference in blood pressure between arms" Emergency, Care and transport of the sick and injured, Tenth edition It is in the textbook but that is all it says. Pretty ambiguous. . Link to comment Share on other sites More sharing options...
DwayneEMTP Posted August 12, 2011 Share Posted August 12, 2011 "A patient with dissecting aortic aneurysm may also exhibit difference in blood pressure between arms" Emergency, Care and transport of the sick and injured, Tenth edition It is in the textbook but that is all it says. Pretty ambiguous. . Yeah, and good on you for looking that up. It also says in there somewhere, another ol' saw, that discoloration from the nipple line up is a hallmark of a Pulmonary embolus. I'd swear that I've see it, though as I've always know that that is what it was, and knew when I saw it the pathology that the pt had died from, perhaps I was seeing what I expected to see. Anyway, one of the docs called bullshit on it one day and many of us where agast! I mean..."Everybody!" knows that this is a fact... So he asked us to explain it anatomically/physiologically...a bunch of us tried for months, just for bragging rights, yet none of us could get it done... So, all things in our books, as accurate as one would expect them to be, at least I would, are not true. But, though I'm not able to debunk the double blood pressures, I've never heard anyone defend it either. Dwayne Link to comment Share on other sites More sharing options...
BushyFromOz Posted August 12, 2011 Share Posted August 12, 2011 The caveat with the difference with B/P in disecting thoracic aortic aneurysms is dependent on whether it extends to the brachiocephalic or left subclavian artery. Type A aneurysms start fromt he base of the aorta and extend to the apex of the arch. Type B's are fom the apex of of the arch to the ?? diaphragm (escapes me atm) For there to be a difference in B/P the aneurysm needs to extend to the vessels i mentioned. The loss of vessel wall integrity and reduced resistance in the brachiocephalic (read as right arm) for example, would show as a difference in B/P with the left arm as the left subclavian (read left arm) is not compromised. Its the effect of the difference in peripheral resistance by the vasculature of the right or left arm. What i don't know is its specificity like i said, pub ammo, nice to know, not very useful in a real world setting. 1 Link to comment Share on other sites More sharing options...
p3medic Posted August 12, 2011 Share Posted August 12, 2011 AAA happens in the abdomen, upper extremity BP should be essentially the same, you may find differences or absence in femorals or lower extremity pulses. The difference in upper extremity BP is in relation to Thoracic Aortic dissection, a different animal entirely. It is not an aneurysm but a dissection between the intima and adventitia layers of the aorta. A case I had a few years ago involved a 37 yo F w/hx of HTN and cocaine abuse, sudden onset of 10/10 chest pain, couldn't sit still, visibly uncomfortable. BLS on scene administered 324 mg ASA and extricated to our ambulance. While giving their report and hooking up our 12 ld the EMT giving report stated a blood pressure of 108/50 (or something thereabouts). When asked what arm he took it in he stated her right. My partner repeated it and got the same, and then took the left which was dramatically higher, lets say 180/100. 12 ld unremarkable, hospital notified of our concern of a likely vascular catastrophe v.s. and ichemic one, immediate CXR on arrival unremarkable, CT revealed a dissection from the base of the aorta to the renal arteries. She went direct to surgery and believe it or not had a good outcome. I realize this is a single anecdotal case, however I tend to get bilateral BP's on pts w/significant chest pain FWIW. Link to comment Share on other sites More sharing options...
BushyFromOz Posted August 12, 2011 Share Posted August 12, 2011 (edited) What he said Edited August 12, 2011 by BushyFromOz Link to comment Share on other sites More sharing options...
jonas salk Posted August 12, 2011 Share Posted August 12, 2011 A had a partner about a year or so ago who on a chest pain patient decided to do a bilateral BP, and then proceeded to freak out when there was a 6 point discrepancy between the systolic pressures. He absolutely insisted we go in on a 4-2 (lights and sirens, on a CTAS 2) for a query TAA. We get there, the triage nurse did a quick visual assessment and rolled his eyes. We ended up having 3 hrs of offload delay with that patient, through which the patient slept comfortably on our bed. My partner on the other hand just paced, fully expected the aorta to explode. Bilateral BPs can be a 'nice to have' piece of information, but unless there are other signs off AAA, unmistakable signs then you really aren't going to catch anything. And sometimes with the wrong hands, a little knowledge is a recipe for disaster. Granted this individual I was working with has at the best of days only a little knowledge. Link to comment Share on other sites More sharing options...
Lone Star Posted August 12, 2011 Share Posted August 12, 2011 It was drilled into my head during my first EMT-B class that the typical B/P has on average a 40 point 'gap' be tween systolic and diastolic pressures. I was further told that widening B/P gaps signified hypovolemia (whether internal or external) and narrowing pulse gaps were indicators of rising ICP (as from closed head injury/CVA). Am I remembering this correctly, or has my alzheimers kicked in again? Link to comment Share on other sites More sharing options...
MedicAsh Posted August 12, 2011 Author Share Posted August 12, 2011 I did trend vitals but honestly I dont remember what they were at this point. I can look at my report when I get to work tonight. Link to comment Share on other sites More sharing options...
tniuqs Posted August 12, 2011 Share Posted August 12, 2011 (Sounds strange but humor me). Elderly Females are a higher risk for Silent MI, but with the very limited PmHx, its anyone's guess. Any "does it ache anywhere else" i.e. referred pain queries. No left shoulder pain ? or a back ache ? BGL is that scope for basics ? And is anyone doing bedside troponins down south ? just one drop of blood from iv start and no brainer. Dwayne to answer your query of Bilateral BP in the geriatric HTN patient: http://www.medscape.com/viewarticle/436713 http://journals.lww.com/cardiologyinreview/Abstract/2004/09000/Simultaneous_Measurements_of_Blood_Pressures_in.6.aspx http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120993/ Link to comment Share on other sites More sharing options...
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