blood pressure reading problems

[Guest]

I'm a student (testing in May), and I'm just not very good with blood pressures. I tried searching the forums for advice but couldn't find much, and google just gave me lots of ways I can control my blood pressure.

I'm not sure where the problem is, so I'll try to outline what I do as carefully as possible in the hope that I'm doing something that can easily be solved. Note: While I am skeptical about the $15 scopes we have on our VAC rig, everyone else uses them fine, so I want to see if my technique is off before I go buying a littman. Also, my hearing is very good.

Assuming I'm practicing on a friend who is wearing a t-shirt, I just put the cuff on with the "---artery---" line roughly on the medial side of the bicep. I usually try to palpate for a pulse roughly half an inch below the elbow, anterior (basically at the top of the forearm). This only works in some people, and my EMT instructor has told me that this won't always work.

I then position the head of the scope or whatever you call it about half an inch below the crease of the elbow but on the anterior end. I've been told not to hold the diaphragm down with my thumb becuase you can get a beat from that, but I've never really experienced that (also on the cover of emergency care and transportation for hte sick and injured, 9th ed, the guy is using his thumb).

I then usually pump it up to about 140 or 150 if I'm expecting a normal reading (classroom setting) and let it slowly drain. Best case scenario: I hear obvious thumps and get a good reading. Worst case scenario: I hear absolutely nothing.

I'd say I get it right about 60% of the time, which isn't good at all. It's always all or nothing for some reason - I never hear faint thumps; either loud or none at all.

I've made sure that the stethoscope I'm using is fine, and that the ear pieces are facing in the right direction. Any tips?

[WAS967 97]

Best I can figure is that the position of the diaphram of your stethescope isn't sitting over an artery in those 40% of cases. I usually start on the medial (toward the body) aspect of the antecubital space (inside of the elbow) and if I don't get a good reading there I move to the lateral (away from the body) aspect.

Remember every patient is different. I find a good stethescope helps, but more for listening to breath/heart/bowel sounds than for BPs. You are correct that for a person with good hearing such as yourself, a cheapo steth works just as well as a $150 Littman.

BTW, if you are looking for a good stethescope that won't break the bank, consider ADC. Both my Wife and I have Adscope 602s and they work great. I was originally looking for a dual bell scope like the Cardiology IISE, but Littman seems to have discontinued those.

[WAS967 97]

Oh and kudos to you for working to perfect your technique. A lot of other people would just say "I can't get it" and reach for the autocuff on the lifepak 12. [-X [-X [-X ](*,)

[Guest alsfirefighter]

Best thing I can keep telling you is to keep practicing and don't lose confidence in yourself. Try not to think about the steps as much and just flow with it. Also try putting the scope on the crease of the elbow and ensure the person arm is flexed in a normal relaxed position. Sometimes having the person or the person may straighten their arm out too tensely and make it a bit more difficult.

=D> That is for you. Too many people are slapping on these automatic blood pressure machines without getting a manual first. This is not clinically sound nor professionally sound.

[Guest NYTruckie]

Pump it up until you can't hear anything (no numbers), if you are having problems hearing I have to agree with WAS (oh the pain) You probally are not on an artery. Sometimes I have problems hearing a BP with my littmann, I will palp a BP to get a ball park systolic and try again. Try asking one of the CLI's for help they are watching you and maybe able to help. Good Luck

[Firemn2742A 14]

Good topic =D> Nice post by anon311

Helpful answers

[Guest]

When my EMT instructor originally told me that you can't palpate on the upper forearm for all people because of muscles etc., one of the people we couldn't get was me. I poked around at my arm for a solid 20 minutes and couldn't palpate the artery up there, and neither culd he.

He told me to try again after doing some exercise (not calling me fat - just to get my pulse up). I just ran two miles, and sure enough I could feel it in the medial antecubital, just like WAS said (thanks).

I'll keep practicing, but in the event that I do end up getting a scope.. is it worth it to get a $70 littman, like the classic?

[Guest NYTruckie]

When my EMT instructor originally told me that you can't palpate on the upper forearm for all people because of muscles etc., one of the people we couldn't get was me. I poked around at my arm for a solid 20 minutes and couldn't palpate the artery up there, and neither culd he. 

He told me to try again after doing some exercise (not calling me fat - just to get my pulse up). I just ran two miles, and sure enough I could feel it in the medial antecubital, just like WAS said (thanks).

I'll keep practicing, but in the event that I do end up getting a scope.. is it worth it to get a $70 littman, like the classic?

I'm Sorry anon I ment Palp a radial pulse, to palp the BP then try again. I would try friends scopes first before you buy any, just to see what you like and if you want to spend the money on a littmann or any other scope.

[x635 4,066]

This is the type of post I love to see on this board, and mainly what this forum is about.

With that said, I have some random thoughts of my own. Excuse me if anything's been said already.

-You won't always be able to hear or palp a BP, don't be afraid to say so if you can't hear one. It may not be you...

-Invest in a quality stethescope. Littmans are the best, IMO. The better quality and model the scope, the better you can hear. Cheap stethescopes are just that. Littman engineering and quality allow more and clearer sounds.

-Look at other signs to get an idea of the ballpark of the BP. If the pt is pale, cool, and diaphoretic, chances are you aren't going to hear one.

-Children under 3, no BP needed or neccesary

-Automatic BP's can be helpful, but can be way off. Always get a manual BP every 5-15, and use the auto for trending

-Practice, Practice, Practice

And kudos for knowing when you need help! Many new EMT's have way too huge of an ego, and will make up a BP when they cannot hear one, which can be detrimental.

[MGMedic 0]

(I hope this doesn't sound silly) Make sure you're placing the earbuds on correctly 100% of the time. Sometimes this is overlooked in classes. The buds should be facing kinda forward (anterior) when you stick them in your ears. Try them on the other way. You will notice how little you can hear. Good luck.

[Guest DADAY]

I have a littmans classic, wanna know where it is? so do i. I hate it. I hear better on the scope that came with the cuff.

[Guest]

anyone else with a classic/select? does that mean it's go for a $150 or dont go for one at all?

[WAS967 97]

I'll keep practicing, but in the event that I do end up getting a scope.. is it worth it to get a $70 littman, like the classic?

anyone else with a classic/select? does that mean it's go for a $150 or dont go for one at all?

I'm with DADAY. The Select sucks. I had one and couldn't stand the single bell design. I prefer dual bell/head scopes like the Adscope 602 I have.

$150 for a scope is a waste of money for most providers. As an EMT it's more than you really need. Like I said earlier, my $80 ADC works just as well if not better than more expensive scopes I've tried. Littman included.

Keep in mind, your scope WILL get lost eventually. Spend the amount of money you are willing to have lost in the line of duty at one point or another. :wink:

[mikeinet 37]

ebay has some good deals. I got my classic for just over $70 bucks with shipping, brand new in the box.

[Guest alsfirefighter]

www.stethoscope.com

I've always gotten pretty good deals from them and what you often end up paying on ebay with others bidding and shipping its about the same price.

I had a select when I first started and it worked pretty well for me. When I started medic class, the department I currently worked for issued me a Littman Cardiology III and I have used that model ever since. It is up there around 150 bucks, but I trust it and am comfortable with it. Up until I accidently left it in the ER (with my name on it no less) and didn't get it returned to me (someone found it but instead of calling they left it there still :roll: ) I had to buy a new one after having the same one for 6 years. New one has named engraved and anyone caught with it this time will have several things engraved on them.

[BuffMedic236 0]

I think that you have been taight well to take BP's but I would consider pumping up the cuff to at least 200 mmHg not 140 or 150. Even though most people reside in that range, you will find that most elderly patients BP's are much higher, ie those with medical problems. Make sure to LEARN what are the most common BP medications out there. It will give you a hint.

Also there is always the all so popular: Vital-Vision

[WAS967 97]

Also there is always the all so popular: Vital-Vision

NO! Please don't teach the new generation of caregivers the lazy habits of the old. You're only doing the patients and caregivers a dis-service.

[Guest]

Thought I'd make an update since so many people gave me helpful ideas. I solved my BP problem (and have been an EMT for a few weeks now) by doing two things.

1) I bought a Littman Classic 2 S.E. Even if its just a psychological thing - which I don't think it is - this scope works better. It just does.

2) Whenever I see the needle start bumpin around for a long time and I still can't hear anything (as was usually the case), I completely shut off the air release from the cuff and move the scope diaphragm around until I can hear the thumping. Then I repump (since I now have the right spot), and do the reading.

Hope this thread helps all the future EMT students who might be struggling with the same thing.

[Guest Orpi442]

arron, The only thing I could add to everyone else is. First attempt to get a bracial BP, By this I mean get everything set cuff on scope on ears, now with one hand or fingers palp the radial pulse as you do this start inflating the cuff until you stop feeling the pulse. Go up a little more and now start releasing pressure. Still palpping the radial pulse when you feel the pulse again that is your top. Now start listening with the scope & donn't be afraid to move the scope around a little to hear the beat. If you get in this habit it is a good way to confirm your BPs. Now for the low number, some times you will not hear it fade away but just stop.

Just remember keep practicing try the other arm & if you do n't get it do not be afraid to say I donn't hear it it happens & you cann't go wrong by being honests. Great post & always remeber there is resourses for you.