NIBP on ALC/CCT transfers

[daedalus]

At my company, we have Zoll monitors for our CCT program. They are horrible at obtaining blood pressures even just walking down the hall in a hospital, never mind the back of the rig moving down the freeway. It is also very difficult to obtain a manuel blood pressure in the back of our CCT unit because of the monitor tray, seatbelt, multiple IVs and vent, and since the patient came from a hospital s/he is covered in blankets. Maybe it is just time to get a new monitor? Or switch to phillips?

How do you deal with obtaining blood pressures in on your ambulance with critical transfers?

 

[ResTech]

Phillips arent always the best at obtaining NiBP either during transport.... I think its just an inherent problem with NiBP in general. As long as you get a manual pressure first and the NiBP is consistently close I say its accurate.

 

[EMTinNEPA]

Phillips arent always the best at obtaining NiBP either during transport....

My employer uses the Philips HeartStart MRx and from my experience and what I've been told, they're almost always within 2 to 8 mmHg of a manual pressure. And this has been on all terrain, from streets in town, to back roads in the sticks, to the interstate. But I agree, it's always best to get a manual pressure first as a baseline.

 

[MSDeltaFlt]

At my company, we have Zoll monitors for our CCT program. They are horrible at obtaining blood pressures even just walking down the hall in a hospital, never mind the back of the rig moving down the freeway. It is also very difficult to obtain a manuel blood pressure in the back of our CCT unit because of the monitor tray, seatbelt, multiple IVs and vent, and since the patient came from a hospital s/he is covered in blankets. Maybe it is just time to get a new monitor? Or switch to phillips?

How do you deal with obtaining blood pressures in on your ambulance with critical transfers?

Preperation on either the AC or the ground. I have no problem rearraging all of the IV's, vent circuit, blankets, or whatever in order to better facilitate me getting each and everything I need.

However, even if all of that is done and I still can't get a BP (which is rare), the AC can land and the truck can pull over.

 

[marineman]

We use Zoll monitors also and many have problems with NIBP. I've found that you need to isolate the arm from vibrations much the same as when doing a manual BP. I will slightly lift the arm so it's not touching the cot and stabilize it just above and just below the cuff. It's not a perfect solution but it helps.

 

[Kage]

Marineman has it figured out.

An automated BP actually is actually less motion tolerant than a manual reading. Most automated BP technologies are oscillometric, meaning the cuff is the sensor as opposed to a microphone or stethoscope. While most of the NIBP algorithms in high end monitors have been tweaked to filter artefact from transport (ground or rotar vibrations), simple patient arm movements can create havoc in the pressure signals from the cuff.

The better you are able to isolate the patient arm movement and avoid contact with the rail, the better and cleaner the signal. This results in quicker and more accurate NIBP readings.

 

[Hal9000]

There is just something inherently satisfying about getting a manual BP. I don't know why, but I've done it countless thousands of times and I still like it. Kind of like sneezing.

 

[Hellsbells]

the AC can land and the truck can pull over.

Seriously? You'd land a flight to obtain a BP?

 

[WuLabsWuTecH]

I'd pull over a truck, but unless I was about to give nitro or something that really needed a clear BP and the BP might be around 100 I don't think I'd call for landing and shutting down the rotor for a bp...

Then again, I don;t work flight med!

 

[austinmedic2004]

I have found that isolating the arm with the NIBP cuff works very well whether in flight or on the ground. Sometimes it may be that the cuff is not snug enough on the arm or there is too much tissue. Moving the NIBP cuff to the forearm or calf usually works when dealing with too much tissue. The numbers are not usually that far off from the upper arm readings.

 

[frdude1000]

Why not Lifepak 12 or 15?

 

[Akulahawk]

We use Zoll monitors also and many have problems with NIBP. I've found that you need to isolate the arm from vibrations much the same as when doing a manual BP. I will slightly lift the arm so it's not touching the cot and stabilize it just above and just below the cuff. It's not a perfect solution but it helps.

I've done this. I agree, it's not perfect, but it does help in getting a reading fairly quickly.

I have found that isolating the arm with the NIBP cuff works very well whether in flight or on the ground. Sometimes it may be that the cuff is not snug enough on the arm or there is too much tissue. Moving the NIBP cuff to the forearm or calf usually works when dealing with too much tissue. The numbers are not usually that far off from the upper arm readings.

I like using the calf as an alternate site, if possible. The forearm usually has too much patient movement or IVs or other stuff in the way. I get a manual if I can get it before I go. If I can't, then I look at how the patient appears and the trend on the NIBP. The numbers might not match exactly up, but often it'll show a clear trend.

Personally, I like ProPaq Encore monitors... but, of course, they can't do Edison Medicine when necessary.

 

[Ditchmedic]

At my company, we have Zoll monitors for our CCT program. They are horrible at obtaining blood pressures even just walking down the hall in a hospital, never mind the back of the rig moving down the freeway. It is also very difficult to obtain a manuel blood pressure in the back of our CCT unit because of the monitor tray, seatbelt, multiple IVs and vent, and since the patient came from a hospital s/he is covered in blankets. Maybe it is just time to get a new monitor? Or switch to phillips?

How do you deal with obtaining blood pressures in on your ambulance with critical transfers?

We use a Zoll CCT monitor everyday. If it starts giving hinky NIBP readings, it needs to have a maintenance tech look at it. Ours does fine, but you need to verify it with a manual BP. I bought a stethoscope that allows me to hear fairly well, even while moving. As far as the PHillips goes, its one sweet machine, I have used it and like it.

 

[absolutesteve81]

I only do manuals, but it is just my preference due to poor equipment at my disposal.

Case in point: Last night I transported a patient that I got a manual BP of 180/100, I was 100% on my reading as I could perfectly hear it. My partner hooked the patient up to the BP machine (as he always does) and it showed a bp of 239/111. I went ahead and checked a manual in that arm (pt hx included a 3cm aneurysm but patient couldn't elaborate on location) and it was the same as my first reading in the other arm.

Our machine is simply this stand-alone POS unit that is attached to the ambulance and I have hardly ever got an accurate reading out of (NEVER while transporting/in motion). So I simply gave up on using it. Now if we got something more reliable, then I might test it out but I have just gave up trusting those things.