Initial blood presure do's and dont's, and lead placement

[boeingb13]

In the dept I was recently hired on with ive noticed one thing that is consistant at most of our stations.

And that is, everyone wants the initial B/P taken manually, and that it should never be taken over a sleeved arm. I have been on units in several of my surrounding counties due to paramedic school ride time, and no one pushes like my dept as far as b/p taking goes.

How do you all feel about it and what is your personal practice.

Second, I have noticed from all the way back to emt school, no teo people like their leads put in the same spots. Some like them next to the clavicles, some like the arms, some like the wrists.

And along with that, some like the upper thigh region, the thighs themselves, the ankles, the top of the ankles the sides as well.

Where do you prefer their placement and why.

I know this is simple stuff, but im always curious as to the habits of different medics. I know many of them have come from, "Thats the way they were shown" and it just stuck with them.

[akroeze]

IMHO initial BP should ALWAYS be manual while the NIBP is checking on the other arm. This establishes two things: Gets your bilateral BP which is always a handy assessment and if the numbers are consistent with both readings you have confirmed that the NIBP is accurate.

[NREMT-Basic]

IMHO initial BP should ALWAYS be manual while the NIBP is checking on the other arm. This establishes two things: Gets your bilateral BP which is always a handy assessment and if the numbers are consistent with both readings you have confirmed that the NIBP is accurate.

I was interested in this method of taking pressures and checked it with my ER doc friend. He is of the opinion that taking pressures on both arms simultaneously will throw off your readings and make them inaccurate. He also states that in his experience and due to anatomical variations (IE location of heart, etc) that left and right side BP readings will generally differ by about 10 points in the systolic.

Also, in school, I have taken BPs over shirts, on bare arms and on the wrist and gotten the same readings and if there is one thing that I absolutely know that I took away from EMT school its how to get accurate BP's.

[JPINFV]

And that is, everyone wants the initial B/P taken manually, and that it should never be taken over a sleeved arm. .

A single layer of fabric, like a shirt, will not have any impact at all on the cuff. Now, yes, the bell/diaphragm should come in contact with the patient, but there are ways to do that without disrobing a patient at all.

[stcommodore]

Ideal practice is to bare the arm and take your first pressure manually. Obviously NIBP shouldn't be trusted with artifact from the road, etc.

Remember 99% of patients will down right strip and get into a gown if we wanted to do so. So take a little effort and make sure you have the arm exposed, cut cloths if necessary.

[BEorP]

Remember 99% of patients will down right strip and get into a gown if we wanted to do so. So take a little effort and make sure you have the arm exposed, cut cloths if necessary.

It often takes more than a little effort to get all ten layers off of granny's arm. As for cutting clothes to take a BP... I'd like to see how that would go over with the patient.

[AnthonyM83]

PHTLS recommends BP's not be taken over clothing and initial BP be taken manually, due to potential for NIBP automatic cuffs making errors based on patient movement/tensing/road-artifact/miscalibration/etc. Just so you don't miss a really critical finding. It makes sense to me.

For 3-leads, I try to place as close to heart as possible and for 12-leads (or if potential of doing a 12-lead) just above ankles and wrists like in the classic pictures (I've seen textbooks give varying answers on this though).

[Christopher.Collins]

I have always preferred a bare arm and a mannual cuff. Granted theres always a human factor where errors can be made, but Id sooner trust my own ears than a machine. Besides... a machine cant give you some readings; strong, thready... etc.

As far as EKG... well Im not a medic yet but my partners have always placed closer to the heart and not on the arms, so thats how I usually do it, unless otherwise told.

[BEorP]

IMHO initial BP should ALWAYS be manual while the NIBP is checking on the other arm. This establishes two things: Gets your bilateral BP which is always a handy assessment and if the numbers are consistent with both readings you have confirmed that the NIBP is accurate.

Is this how you actually assess patients? I hope that doesn't sound negative in any way but I am really just curious to know if it is how you do it or if you're just mentioning what might be the ideal way to do things in an ideal world.

[MSDeltaFlt]

In the dept I was recently hired on with ive noticed one thing that is consistant at most of our stations.

And that is, everyone wants the initial B/P taken manually, and that it should never be taken over a sleeved arm. I have been on units in several of my surrounding counties due to paramedic school ride time, and no one pushes like my dept as far as b/p taking goes.

How do you all feel about it and what is your personal practice.

Second, I have noticed from all the way back to emt school, no teo people like their leads put in the same spots. Some like them next to the clavicles, some like the arms, some like the wrists.

And along with that, some like the upper thigh region, the thighs themselves, the ankles, the top of the ankles the sides as well.

Where do you prefer their placement and why.

I know this is simple stuff, but im always curious as to the habits of different medics. I know many of them have come from, "Thats the way they were shown" and it just stuck with them.

As far as BP goes: I like manuals on bare skin. They are more accurate. Yes, one layer of thin cloth won't make any difference, but keeping good habits greatly decrease your risk of compromise when your pt cannot afford for you to compromise.

As far lead placement goes: It depends. If you want to just monitor, then it doesn't really matter where you place the leads - clavicles, arms, wrists. All you're looking for is the HR.

If you're looking to assess, then lead placement is key. RA stands for Right Arm. Put it on the right arm. The further down the arm the better, but it must be on the arm. The same thing goes for LL. "Left Leg", not "Left Lower" abdomen. If the leads are not in the correct place for assessment, then the readings will be "skewed" and, therefore, completely wrong.