Blood Pressure: ALS v. BLS

[sirengirl]

It weas never a question of being comfortable transporting this patient- she was having a perfect conversation with me, and like I said A&Ox3, my only concern was whether I should have pushed for the ECG to ensure the best patient care was being handles in order to minimize risk of improper care.

 

[Smash]

Wouldn't a myriad of signs and symptoms come charging before any ekg manifestations in the case of a bleed? (I remember reading an old article discussing this, but haven't really ever heard anything else about it.)

Absolutely, hence saying that it's not necessarily going to diagnose the sub-arachnoid. There's no reason to expect any in this patient anyway.

 

[Anjel]

What are you expecting this EKG to show?

That there is nothing cardiac relating to the BP.

If there isn't. Ok we are good to go. I will take her and "babysit" her to the hospital.

 

[Lifeguards For Life]

It weas never a question of being comfortable transporting this patient- she was having a perfect conversation with me, and like I said A&Ox3, my only concern was whether I should have pushed for the ECG to ensure the best patient care was being handles in order to minimize risk of improper care.

I'm not questioning the level of care you provided. I think you did perfect.

To answer your question, while I don't think you should of "demanded" or "pushed for" an ekg, but you could of asked the medic about it. A simple "hey what do you think about an ekg" would of been fine. The medic may of done one for you, or more likely, nicely explained their reasoning to you.

Never be afraid to ask

 

[Shishkabob]

It weas never a question of being comfortable transporting this patient- she was having a perfect conversation with me, and like I said A&Ox3, my only concern was whether I should have pushed for the ECG to ensure the best patient care was being handles in order to minimize risk of improper care.

No one was questioning your comfort ^_^



As an add on to LFL, it's how you phrase it.

"Hey what did the EKG show? Oh, you didn't get one? Could you do one for me as I'm trying to learn EKGs"

 

[Lifeguards For Life]

It's not about comfort. It is about if something was to happen to this pt with that high of a bp for no reason and no ekg to say that it isnt cardiac related. There is nothing I could do for that pt.

If the BP was that high. But everything else about the pt was perfectly normal then no I wouldn't have a problem taking them.

For the pt, I want them to have the best resources available to them in case they decided to take a turn for the worse.

well if the bp is high for no reason, there is no reason to worry then.

Or if the BP is a little high(or even just plain high) because they have a history of hypertension, there is, again, no reason for worry.

 

[sirengirl]

No one was questioning your comfort ^_^



As an add on to LFL, it's how you phrase it.

"Hey what did the EKG show? Oh, you didn't get one? Could you do one for me as I'm trying to learn EKGs"

I was just clarifying in case anyone did. In fact I feel better about the pt being transported with me as she was because her history of depression- we had a nice long conversation in her ER room about her family and such while I waited for the long turnover time due to the high call volume at that time. I don't feel like said paramedic would have had the patience to sit down in a chair next to her and chat while waiting for the ER backlog to catch up. In no way do I say this should be done with every patient- but the situation and time seemed appropriate for it considering that I'd already been working with her for over 20 minutes in her home. A stranger may or may not have had the same compassion.

 

[Anjel]

well if the bp is high for no reason, there is no reason to worry then.

Or if the BP is a little high(or even just plain high) because they have a history of hypertension, there is, again, no reason for worry.

why is it high if they took their medication?

All I ask is for an ekg. And after that and the medic says ok you are good to go. Then ok we will go. The medics here would never leave once on scene either.

The way the OP stated it. Was the medics that showed up, checked a bp and said peace.

Again if they took the time, assessed the pt, said that they were ok. Then ok I will take them.

Better safe then sorry.

BTW...Just because I don't like what you are insinuating. I have never turned down a pt. Or said no because I wasn't comfortable. I am just saying that depending on the situation and ALS on scene. If I didn't want to take them. I wouldnt have to

 

[Lifeguards For Life]

Can one of the basics posting in this thread (meaning not Linuss ) explain to me what cardiac complications you believe may be underlying in this particular patient?

 

[Smash]

why is it high if they took their medication?

All I ask is for an ekg. And after that and the medic says ok you are good to go. Then ok we will go. The medics here would never leave once on scene either.

Better safe then sorry.

Why do you ask for an EKG? What symptoms is this patient exhibiting that makes you suspect there could be a thrombo-occlusive event occuring? I'm struggling to see a connection between essential hypertension and a 12 lead.

Edit: Sorry, Lifeguard got in before me.

 

[usalsfyre]

Hmmm, if I remeber the AHA guidlines correctly, a B/P of 200/97 would get discharged from the ED with a script for oral antihypertensives and a note to follow up with the PCP. 220/110 is where they begin to treat. Anything less than 180 systolic doesn't even get the script.

I'd be suspicious of the diastolic of 160 from the NIBP. It's also important not to get confirmation bias from the NIBP when taking a manual pressure. A big deal is often made of hypertension, when in reality, most people aren't waiting to stroke out on you. When was the last time this patient saw here PCP? EMS is trained to think zebra's when they hear hoofbeats, in reality 75% of the time it's just plain old horses.

I would probably have taken the patient, just because the BLS truck has shown themselves to be uncomfortable with the patient. However, I don't fault the medics for releasing the patient to BLS. Diarrhea is not exactly a sign of occult stroke or MI. It comes down again to education ("not this cr@p again usalsfyre!"). EMT-Basics (and for the most part medics) are taught and expected to overtreat to make up for knowledge gaps in their assesment to determine life-threatening from non-life-threatening.

 

[Anjel]

Why do you ask for an EKG? What symptoms is this patient exhibiting that makes you suspect there could be a thrombo-occlusive event occuring? I'm struggling to see a connection between essential hypertension and a 12 lead.

Edit: Sorry, Lifeguard got in before me.

I want an assessment by the ALS I called. If I thought that pt needed ALS then I want them to assess. Not just take a BP.

I am talking in general. Idk that I would of called ALS for that pt. But if I did, I want them to make sure they are ok before I take them.

The OP provided HR, RR, and BP. and said they were calling ALS. SO if she thought they needed ALS I am just going with that decision and building from there.

 

[Shishkabob]

A Paramedic level assessment is that level not just for the tools used to assess, but the education/ knowledge behind such assessment, with (hopefully) an understanding of not just physiology, but pathophysiology.

 

[usalsfyre]

I want an assessment by the ALS I called. If I thought that pt needed ALS then I want them to assess. Not just take a BP.

I am talking in general. Idk that I would of called ALS for that pt. But if I did, I want them to make sure they are ok before I take them.

The OP provided HR, RR, and BP. and said they were calling ALS. SO if she thought they needed ALS I am just going with that decision and building from there.

I can do a pretty good assesment without a 12 lead EKG. If the patient has no complaints, numbers aren't neccesarily a good reason to run diagnostic test.

"ALS" is not about the tools, it's about the knowledge.

(Linuss beat me there)

 

[Anjel]

Instead of attacking and thinking that I am absolutely ridiculous. Why don't you explain your decision in the hopes someone could learn something.

I am a brand new basic. There isn't much that I am comfortable with. But I do my job. I've never had to call ALS. But if I do that means that I don't think I could handle it. And would like them to either take the pt, or assure me that it is ok.

 

[Anjel]

A Paramedic level assessment is that level not just for the tools used to assess, but the education/ knowledge behind such assessment, with (hopefully) an understanding of not just physiology, but pathophysiology.

But from what the OP said they did not do a paramedic level assessment. They did a BP and said cya bye

 

[Lifeguards For Life]

I want an assessment by the ALS I called. If I thought that pt needed ALS then I want them to assess. Not just take a BP.

I am talking in general. Idk that I would of called ALS for that pt. But if I did, I want them to make sure they are ok before I take them.

The OP provided HR, RR, and BP. and said they were calling ALS. SO if she thought they needed ALS I am just going with that decision and building from there.

That's not good enough. Why do you think the patient needs ALS?

None of the medics here mean to insinuate anything negative, but this level of thinking should be obtainable at the basic level.

 

[Smash]

I can do a pretty good assesment without a 12 lead EKG. If the patient has no complaints, numbers aren't neccesarily a good reason to run diagnostic test.

Indeed, I have zero suspicion that this patient is having an acute ST elevation myocardial infarction, so I have no reason to do a 12 lead. The blood pressure really doesn't concern me at all, and even if it did, it bears no relation to what I may or may not see on a 12 lead (i.e. probably nothing, maybe a strain pattern, who knows, and really...)

 

[Lifeguards For Life]

Instead of attacking and thinking that I am absolutely ridiculous. Why don't you explain your decision in the hopes someone could learn something.

I am a brand new basic. There isn't much that I am comfortable with. But I do my job. I've never had to call ALS. But if I do that means that I don't think I could handle it. And would like them to either take the pt, or assure me that it is ok.

Oh we will explain eventually. But this is something you can think your way through, even if you are a new basic. I have faith in you.

I am a firm believer that by not spoon feeding, and allowing you to struggle with this problem here, you will learn something that you can take with you to the field.

 

[Anjel]

That's not good enough. Why do you think the patient needs ALS?

None of the medics here mean to insinuate anything negative, but this level of thinking should be obtainable at the basic level.

For this particular pt I don't know if they needed ALS.

If it was only the BP that was out of the ordinary then I probably would of just loaded and go.

But obviously there was something that made the OP call.