Taking Blood Pressure

June 14, 2005 10:54 AM

I'm an EMT student and I some times have trouble hearing the blood pressures in the ambulance and hospital, does anyone have good advice on taking them?
posted by sicem07 to science & nature (10 comments total)

It's usually quicker (and arguably more accurate) finding the systolic pressure from a radial pulse. In an emergency situation, it's often the more useful data point. You can check your stethescope finding by this method anyway. And if someone is shocked, it's often really really hard to hear a 'true' diastolic pressure - it just seems to fade away. I used to use a pediatric head on my stethescope in a vague attempt to be more accurate, but I think in an ambulance it might just delay finding the sweet spot.
posted by peacay at 11:39 AM on June 14, 2005

Watch the needle on the gauge. As you release the pressure, it will start to jump. The point at which it starts to jump is NOT the systolic pressure -- the systolic will be lower. You can use the jump, though, because the audible thump will be on the same "beat," if that makes sense. It's easier to hear when you're waiting for it.

Don't worry about it too much, though. You'll do about 50 BPs and you'll wonder how you ever thought it was tough to hear.

If you have a double sided stethescope, using the bell will make it a lot clearer, especially on the diastolic. Don't go buy one, though, if you don't already have one.
posted by LittleMissCranky at 11:48 AM on June 14, 2005

Slip the stethescope under the cuff to help hold it there.
posted by gramcracker at 12:23 PM on June 14, 2005

Just to clarify what I wrote - you feel the radial pulse with your fingers and pump the cuff up and the systolic pressure occurs at the point when you feel the pulse return as the air is released. And/but I think the other ideas mentioned are helpful - often it's a matter of changing your practises to suit yourself and the patient and the circumstances.
posted by peacay at 12:39 PM on June 14, 2005

Littman Cardiology III for the win. After using a Hewlett-Packard all through med school, the Littman was like turning the volume up to 11.

God forbid someone should cough or speak while you're auscultating, though - you'll suffer permanent hearing loss.
posted by ikkyu2 at 5:30 PM on June 14, 2005

I love the Cardio III, ikkyu2, but would you really buy a $150 stethescope just for blood pressures and other EMT stuff?
posted by LittleMissCranky at 6:40 PM on June 14, 2005

Thank you. I am happy to learn I am not the only one who has trouble hearing in a stethoscope. I could never hear anything but the 'ocean' in one of those.
posted by Goofyy at 1:51 AM on June 15, 2005

I loved the needle jumping method because I could read my own BP while someone else was taking it with the stethoscope, however, the needle jump method may not work on an ambulance, where bumps in the road will make the needle jump on its own. I was told by my instructor that if you can't hear it and the needle jump isn't practical, then you don't report it. His reasoning was that if you've got someone on the way to the hospital who is breathing, has a pulse and isn't bleeding, you're doing your job. Everything else is icing.
posted by plinth at 4:55 AM on June 15, 2005

I love the Cardio III, ikkyu2, but would you really buy a $150 stethescope just for blood pressures and other EMT stuff?

No. I'd buy a $150 stethOscope.

Spelling aside, blood pressure is probably the most important thing that stethoscopes are used for. Listening for borborygmi and heart murmurs is all well and good but for diagnostic purposes in the thorax and abdomen, ultrasound supplanted the stethoscope decades ago.

EMT taking blood pressure is not a trivial or unimportant thing. It's pretty vital. That's why they call it a 'vital' sign. It's actually not only important to measure BP; it's also important that the measured value actually be correct. For this, you need the right tool, to enable you to hear all 5 Korotkoff sounds.

The right tool, in my experience, is the Littman Cardiology III. Jumping needles, to take one of the execrable above suggestions, are easy to see but trying to divine an accurate or precise blood pressure from them is something like haruspices.

One of the things I've always loved and hated about medicine is that there's generally one right way to do things.
posted by ikkyu2 at 6:39 PM on June 19, 2005

First of all, I did not say to use the jumping needle to measure the blood pressure. I said to use it to help you hear the first Korotkoff sound when you're not accustomed to hearing it.

Second, although I certainly agree that an accurate bp is indeed important, you don't need a terribly good stethOscope (apologies) to get it. An expensive stethoscope is necessary to hear distinctions between Korotkoff sounds, but EMTs are generally only taught I and V. Hearing I and V accurately and clearly does not take the same level of auditory crispness as general auscultation.

I would also hasten to add that the "one right way to do things" does not always include overkill.
posted by LittleMissCranky at 7:25 AM on November 3, 2005