Automatic vs. Manual BP

[fiznat]

I'd like to hear everyone's thoughts on how accurate they think NIBP ought to be. I mean, sure we would all like the technique to be as precise as possible, but does it really matter? How narrow do the margins of error need to be? In emergency medicine, would you guys say that 10 points change in two back-to-back BP readings represents a serious physiological change? Is there a moment in your prehospital care where 5 or 10 points in blood pressure will make the difference in how you treat a patient? Can we be happy in the knowledge that NIBP is an estimate and not necessarily precise?

Example: my protocols indicate that NTG should not be given to patients with systolic blood pressures under 100. Does that mean that the patient with a systolic of 101 gets NTG while the patient with a systolic of 99 does not? Should our definition of these things really be so narrow?

Edited July 1, 2009 by fiznat

[HARDCORE CAP]

i personally don't trust machines. from what i've seen, little, if any get proper maintenance to remain accurate and on top of it i don't trust a machine to hear like a person can; to tell the difference between a random noise and a BP "thump". i agree that i'd like to see a study where it's IBP vs Manual vs Automatic

[tniuqs]

Standing orders that rely on BP readings should specify by which method this vital sign must be obtained. The whole idea of a "normal blood pressure" should be reconsidered, leaving the question: What is the definition of a "true blood pressure reading"?

I think this sums it up nicely .. standing orders i.e. treatment for shock" baaa and based on a very time sensitive and individually variable v/s ... maybe we as practitioners should look to "other" v/s, as in pulse rates, IF the pulse ox is correlating and what meds could be on board?

Heres why .. had a 58 y/o male, put his motorbike into a logging truck, obvious fracture compound femur, 126/94 (manual), shocky looking, concussed grade 3, a poor historian with GCS of 13 at best and an NSR of 62 ? ... was he on beta blockers ? .... that was my suspicion ...

So treat the numbers OR end organ perfusion, dump the standing order based on the little boxes and flow charts.

ps I have never trusted the NIBP ... after playing with them in ICU and a REAL art line (calibrated) in-situ ... sorry no study just a slow day on the unit and rectal temp must be 10 cm up to be accurate.

[iMac]

An interesting article. I have out of habit always taken my own BPs (as I've always trusted my skills more than that of a machine). There have been a few occasions where the BP I was getting from the monitor didn't seem to quite add up with the rest of my vitals and/or patient condition.

I wouldn't mind reading more studies on this.

[irlemt]

Not to knock anyone but how accurate are your ears? I recently showed someone how to take a BP with Spygh and stethoscope, they couldn't hear the systolic sounds when I heard them. Now if we were working together and were both taking BP's on a single patient we would get 2 different readings. Another point how often are your Spygh's serviced and calibrated? We have some in use that are nearly 10 years old and never serviced. It's not just machines that need to be calibrated. A few years ago I had a 24 hr blood pressure device on me ( automatic cuff inflated at reg times during the day and night) to check for Hypertension. Now my Doctors treatment decision was based on the findings of machine BP's.