Blood Pressure?

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Caspar

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I am a new EMT and I'm having trouble hearing BP's in general on calls. I can obtain them fine at home and on friends, but when its the patient, I hear nothing. I'm not sure whats going on, maybe nerves? Any tips on finding a BP?
 
Make sure you have the stethoscope in your ears correctly, try to limit outside noise, place your stethoscope as close to the artery as possible, make sure you are using the correct sized BP cuff.

Practice, practice, practice. Some people find that buying a higher quality stethoscope helps a lot.
 
A lot of your patients will have all sorts of pathologies that can make it harder to hear BPs, feel pulses, etc. So don't feel too bad, just keep practicing.

It will obviously help to get a BP before the truck starts moving.
If you can't hear it on one side, the other side might be better.
If you can't hear it, hopefully you can palpate it.
As above, the right size of cuff makes a big difference - don't be afraid to pull out the pedi cuff or the thigh cuff for smaller / larger patients.
Also as above, buying a nice stethoscope will make your life a lot easier.
How they're holding their arm can make a difference - I find that straightening the arm out completely helps.
 
Your friends are probably much more compliant (they keep their arm straight and don't squirm) and lean/healthy than your patients. Practice better straightening and supporting the arm.
 
DesertEMT66 said:
Make sure you have the stethoscope in your ears correctly, try to limit outside noise, place your stethoscope as close to the artery as possible, make sure you are using the correct sized BP cuff.

Practice, practice, practice. Some people find that buying a higher quality stethoscope helps a lot.
Click to expand...
Gurby said:
A lot of your patients will have all sorts of pathologies that can make it harder to hear BPs, feel pulses, etc. So don't feel too bad, just keep practicing.

It will obviously help to get a BP before the truck starts moving.
If you can't hear it on one side, the other side might be better.
If you can't hear it, hopefully you can palpate it.
As above, the right size of cuff makes a big difference - don't be afraid to pull out the pedi cuff or the thigh cuff for smaller / larger patients.
Also as above, buying a nice stethoscope will make your life a lot easier.
How they're holding their arm can make a difference - I find that straightening the arm out completely helps.
Click to expand...
Thanks for the tips. I find that whenever I'm trying to take a BP, the patients arm is bent. Maybe this is the reason I can't hear it. It's just sometimes they are in such distress that they are squirming and won't keep the arm straight. I guess there is nothing I can really do about that except keep practicing on calls
 
Also any tips on obtaining a BP on overweight or elderly patients who have a lot of skin near the auscultation site?
 
As said before, straightening the arm and listening closer to the artery works very well to improve your sound on any patient.

Someone having more skin doesn't really concern me, I can pretty much hear in the same manner.
 
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STXmedic said:
I don't understand the difficulty... All you do is press a button, right?...
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STXmedic said:
I don't understand the difficulty... All you do is press a button, right?...
Click to expand...
But real EMTs and paramedics...

Ima stop you there tho.
 
frodo25 said:
Thanks for the tips. I find that whenever I'm trying to take a BP, the patients arm is bent. Maybe this is the reason I can't hear it. It's just sometimes they are in such distress that they are squirming and won't keep the arm straight. I guess there is nothing I can really do about that except keep practicing on calls
Click to expand...

Always straighten it. Rest their elbow on your knee/thigh and roll their arm so the AC is facing upward. Make them relax fully. Then palpate the AC until you can feel the brachial pulse there.

Once you have that, worst case is you can get a palpated pressure. But auscultate where you felt the pulse and you'll usually hear it.

Put them the way you want, don't try to maneuver around someone doing the tango.
 
frodo25 said:
I am a new EMT and I'm having trouble hearing BP's in general on calls. I can obtain them fine at home and on friends, but when its the patient, I hear nothing. I'm not sure whats going on, maybe nerves? Any tips on finding a BP?
Click to expand...
Me too!!!!!
 
Make sure their feet arent crossed. Learned that one. Raises BP and you will get an inaccurate reading.
 
[QUOTE="Brandon O, post: 580529, member: 6195"Then palpate the AC until you can feel the brachial pulse there.[/QUOTE]

THIS! If you can feel the target, you know exactly where to put your stethoscope. It won't always be possible, but it sure helps in a lot of cases.
 
If everything fails I would just palpate the systolic with no stet :) (this can be hard on some patients too thou).
 
You don't have to use the AC either, for patients with PVD or other vascular issues I often have better luck with a brachial placement than the AC. Some people just don't have a humerus long enough for the cuff and scope in that spot though :)

Other people are so large that you'll only be able to get a BP on their forearm, and maybe not even then.
 
Interesting about the NIBP machine.

I had an interesting patient with a language barrier this weekend.

My manual BP kept coming to about 170/120 and confirmed manually by other providers.

The paramedic's machine insisted it was 146/92.

I find that even with a lot of ambient noise, I could hear that guy crystal clear.

It's the low BPs (90 systolic or lower) or the low pulse pressures (120/104 ish) that I have a hard time hearing... Possibly because I also have a hard time palpating the pulse... Was that the pulse, or the dancing rhinos next door?
 
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