? about BP; Hypotension

[wrmedic82]

I guess you can call vital signs WNL if you compare them to what is written in literature. However like others have said vital signs are relative to the patient. Its not a bad idea to ask the patient what thier norms are.

[tskstorm]

I guess you can call vital signs WNL if you compare them to what is written in literature. However like others have said vital signs are relative to the patient. Its not a bad idea to ask the patient what thier norms are.

I hope you attach that literature to your ACR otherwise your going to be out of luck in court. A dozen slick lawyers asking you how you know what the patients normal limits are, and you say we saw XYZ literature, they say well where is it? You = screwed.

[emsboy_2000]

Ok so I have my EMT-I, and I have a question about hypotension.

First, when is a BP reading in a normal, healthy adult considered to be hypotensive. I've looked back in my book and it says that a normal systolic BP is 90-140 systolic, but it does not say what the normal Diastolic BP is.

Please help me with this, and if you have any questions or need me to explain it better let me know.

In recent years there has been a continuing reconsideration of what is deemed a normal blood pressure (BP) reading. While most experts believe that 120/80 is an optimal BP reading, current research suggests that 115/75 is the new optimal.

But to address your question of hypotension on a “normal, healthy adult” (greater than 15 years of age), a systolic BP of less than 80, OR less than 90 AND exhibiting signs of inadequate perfusion: altered mental status, tachycardia, pallor or diaphoresis is considered shock. So, in other words, a systolic BP between 80 and 90 without physical symptoms is considered normal—keep in mind those petite females and athletes, for example, who can sometimes run a systolic BP in this range normally; however, anything less than 80 with/without physical symptoms is usually considered abnormal. Granted, someone in an earlier post mentioned that to “know what…[a patients] ideal blood pressure [is] or even [know] what a normal BP is…serial readings” must be taken. While this may be true, a pre-hospital health care provider does not have the luxury to sit with a patient all day, take BP readings at certain times of the day—or whatever it may be, and then determine their normal BP. Hospital healthcare practitioners do that.

Specifically, you asked what a normal diastolic BP was. Some experts define low blood pressure as readings lower than 90 systolic or 60 diastolic—you need to have only one number in the low range for your blood pressure to be considered lower than normal. In other words, if your systolic pressure is a 120, but your diastolic pressure is 50, you are considered to have a lower than normal BP measurement. However, this is not true for everyone—as I mentioned earlier. What is considered low BP for one person may be normal for another (i.e., petite women/athletes). For that reason, physicians will usually consider a chronically low BP too low only if it causes noticeable symptoms.

For an even deeper understanding of hypotension/shock, I’ve attached the following link.

www.ems1.com/medical-clinical/articles/479223-Blood-Pressure-Assessment-in-the-Hypovolemic-Shock-Patient

I hope this helps, emti2008.

Edited April 16, 2009 by emsboy_2000

[wrmedic82]

I hope you attach that literature to your ACR otherwise your going to be out of luck in court. A dozen slick lawyers asking you how you know what the patients normal limits are, and you say we saw XYZ literature, they say well where is it? You = screwed.

When a patient tells you their norm, provided they know their norm, its something to keep in hindsight. You always treat the patient based on chief complaint, and clinical presentation. A patient may have their normal BP and still be dehydrated if that is their clinical presentation, or it may be elevated in some circumstances. Common sense wont hurt much either (unless common sense lies to you frequently) . Another thing to consider is protocols. In our system if someone has a systolic below 90,according to hypotension protocols they get a initial 250ml fluid bolus, then give 20cc/kg (standard) to maintain a systolic at or above 90.

In recent years there has been a continuing reconsideration of what is deemed a normal blood pressure (BP) reading. While most experts believe that 120/80 is an optimal BP reading, current research suggests that 115/75 is the new optimal.

nd then determine their normal BP. Hospital healthcare practitioners do that.

Just curious and don't take this as sarcasm but when did BP have odd numbers vs even numbers.

I am not much for monitors as Ive seen them be drastically off too many times. funny case and point was watching the monitors BP cuff take a pressure while not being attached to the patient or anyone for that matter. I am sure routine calibration would fix that. I just like sticking to old reliable spigmomanometer and stethoscope

[Kiwiology]

if you have a 23 y/o female Pt. taking a Ca channel blocker, c/o dizzyness and is slightly lathargic and the BP reading is consistently 99/58 to 99/68 (taken q5min), is it considered hypotension, and what would be the definitive treatment.

"Hypo" simply means lower than "normal" which is kind of subjective ... the National Heart Lung & Blood institute's website now says hypotension is a BP of < 90/60.

As for treatment, well .... is the patient physiologically stable or are they showing signs of hypoperfusion? I've seen a guy with a blood presssure of 80/50 up dancing around (well not quite but you get the idea) whereas when I got sick last I was running a pressure of about 90/70 and I was pretty cold and pale.

BP, heart rate etc are helpful in guiding you towards your diagnosis or showing you where to look for further evidence; ok so this guy's pressure is way low, could be cardiac, could be renal, could be that he has a big ass wound and is loosing lots of blood etc

[emsboy_2000]

wrmedic82,

I'm sorry, but you'll have to elaborate more on your question? Aside from being vague, it is poorly worded; I did not understand your line of thought. Thank you.

Edited April 16, 2009 by emsboy_2000

[wrmedic82]

wrmedic82,

I'm sorry, but you'll have to elaborate more on your question? Aside from being vague, it is poorly worded; I did not understand your line of thought. Thank you.

ok on a spigmomanometer the numbers are only even. My question is how did they get 115/75 being optimal when both numbers are odd. I thought I was clear when I asked..my bad

[emsboy_2000]

ok on a spigmomanometer the numbers are only even. My question is how did they get 115/75 being optimal when both numbers are odd. I thought I was clear when I asked..my bad

Okay, I thought that's what you meant; however, I wanted to make sure before I responded.

Yes, you are correct, there are only even numbers on a gauge; however, electronic BP monitors (to which you're not very fond of, I understand) will produce every whole number—except for zero, of course. Mechanical BP units are simply designed to register numbers by increments of two or even numbers. But that doesn't mean that a BP of 120 registering on your gauge isn’t really a BP of 119 or 121. Now, obviously it’s not a big deal in the least. But, like I’ve said, that’s just simply the way they’re built. Even-numbered BP's do exist, though.

Hey, thanks for your question.

Edited April 16, 2009 by emsboy_2000

[JPINFV]

Without getting a source for the study/review article, we may never know. Machine readings (invasive and non-invasive BPs) will give readings in odd numbers. What struck me is that the 'new' numbers are with in the margin of error for manual BPs anyways.

[emti2008]

Is that the patients normal BP while on her medications or is that her un-medicated BP? It's possible that her BP was reduced too quickly by her medications thus the symptoms. Anti-hypertensives are normally titrated to desired effect to avoid these kind of circumstances. If the patient is alert and oriented with adequate perfusion, BP over 90 systolic, in NSR, there really isn't anything to be done pre-hospitally for her. She does need to be transported to a hospital where they can review her medication situation and adjust dosages however.

Pt. states that that is the BP while not on the Medication; and can't some calcium channel blockers lower the potassium level?

An other option is the MAP. Most NIBP cuffs will calculate this for you. In general a MAP should be 60 or greater.

I'm sorry but what is a MAP. I don't remember learning that one.

For an even deeper understanding of hypotension/shock, I’ve attached the following link.

www.ems1.com/medical-clinical/articles/479223-Blood-Pressure-Assessment-in-the-Hypovolemic-Shock-Patient

thank you I'm about to look at it now.

Tnak you all for your information, it really helps, I'm still new at this.

Edited April 17, 2009 by emti2008