BP Question

[island emt]

try different types of ear muffins for a better seal to your ears. the standard round tips are not a one size fits all.

[MikeEMT]

Just curious, what is your reason for rarely palpating blood pressures?

Why palpate when I can auscultate. We respond with the fire dept and fire usually "palpates" the BP on their initial assessment. However, I have come to find out that either the majority of the population has a bp of 120/p or quite a few of the Firefighters aren't accurately doing an assessment. I always redo an assessment when taking over patient care and usually prefer to auscultate.

That said I am not above palpating. I had a patient who was 2yo the other day. We don't carry a stethoscope that small so I palped the BP. If I am in a hurry due to patient needs I will palpated it as well.

So basically it is personal preference. I do compare the vitals I obtain with what we get at the hospital and I find that I am usually pretty accurate.

Edited April 10, 2013 by MikeEMT

[MariB]

I find the cheapo stethoscopes hard to hear with. However my Littmann which is the $50 model is a dream. It might just boil down to the Littmann fitting my ear better though. I have no need for a Cardiology stethoscope but a few of our EMT's have them. Personally I wouldn't waste my money on a $150 scope.

I don't like to palpate and I rarely do it. Only time I palpate is if patient condition warrants it or if I cannot auscultate. In the ambulance I just isolate the arm. We have Mercedes Sprinters though and even though they are diesel they are not noisy. I can still auscultate even in our old Ford type II's that we use for spares.

A $50 Stethoscope is considered a "Cheapo"

$30, $50, $75 or $300, use whatever works for you. However, it is not easy to press "lightly" while obtaining A bp. You usually have their arm tucked under yours, they are talking etc. Pressure is inevitable.

I do have a need for a Cardiology Stethoscope as I have a hearing deficiency . I couldn't hear breath sounds or obtain a BP with my $75 Littmann , I now have the Master Cardiology. No it is not a waste of money, and it was $210. I could not have continued in class without one.

I can hear their thoughts with it. lol

Why palpate when I can auscultate. We respond with the fire dept and fire usually "palpates" the BP on their initial assessment. However, I have come to find out that either the majority of the population has a bp of 120/p or quite a few of the Firefighters aren't accurately doing an assessment. I always redo an assessment when taking over patient care and usually prefer to auscultate.

That said I am not above palpating. I had a patient who was 2yo the other day. We don't carry a stethoscope that small so I palped the BP. If I am in a hurry due to patient needs I will palpated it as well.

So basically it is personal preference. I do compare the vitals I obtain with what we get at the hospital and I find that I am usually pretty accurate.

Very lucky, It is not easy to get a blood pressure cuff even near a 2year old.

"they" I put that in quotes because it has been said over and over and you hear it in class yadda yadda , that you are supposed to pull over to Auscultate , So I, with all my clinical work etc, choose to Palpate.

Observing and running with ALS units, they always Palpated also.. And it isnt common to get 120, most people being transported, are running 120. But whatever works for you, works, why not stick with it?

and Why dont you guys have a PEDs bag with a small stethoscope? Do you have special rigs you usually use for pediatrics?

Edited April 10, 2013 by MariB

[MikeEMT]

A $50 Stethoscope is considered a "Cheapo"

$30, $50, $75 or $300, use whatever works for you. However, it is not easy to press "lightly" while obtaining A bp. You usually have their arm tucked under yours, they are talking etc. Pressure is inevitable.

I do have a need for a Cardiology Stethoscope as I have a hearing deficiency . I couldn't hear breath sounds or obtain a BP with my $75 Littmann , I now have the Master Cardiology. No it is not a waste of money, and it was $210. I could not have continued in class without one.

I can hear their thoughts with it. lol

Very lucky, It is not easy to get a blood pressure cuff even near a 2year old.

"they" I put that in quotes because it has been said over and over and you hear it in class yadda yadda , that you are supposed to pull over to Auscultate , So I, with all my clinical work etc, choose to Palpate.

Observing and running with ALS units, they always Palpated also.. And it isnt common to get 120, most people being transported, are running 120. But whatever works for you, works, why not stick with it?

and Why dont you guys have a PEDs bag with a small stethoscope? Do you have special rigs you usually use for pediatrics?

$50 stethoscope cheap? Wow I want to work in your system if you think that is cheap, lol. If you have need for a Cardiology or other high end stethoscope then that is one thing, however if you are buying one just because "it looks cool" then it is a waste of money. At the basic level where we auscultate BP's and Lung sounds its not really necessary to go that high end. If I had to assess heart sounds our bowel sounds then yeah it might be different. You sound like you have a legitimate need for one, we have a bunch of EMTs that run around with the cardiology because it is "cool." Personally, I can think of better things to spend my money on.

I got two little girls myself, a 3yo and a 5yo. I am very good with pediatric patients and have never had an issue with assessing pediatrics. Never had a problem getting a bp from a pediatric.

We don't have specific pediatric bag because we don't deal with pediatrics that often. We do carry pediatric equipment though and part of that is pediatric stethoscope. I don't know where it disappeared to on my ambulance as I was using a spare. On my normal rig it hangs on the medic catcher. One of the reasons I hate spares is because people pilfer equipment out of them. When you have a fleet of approximately 100 ambulances just for our area, not hard to imagine some equipment running off. I informed my supervisor of this and they will order more. If patient was super critical I could have probably used my littmann or the dual head that is in our jump bag.

We do have dedicated ambulances for children though. We have two stationed at Seattle Childrens' Hospital both are specially designed for BLS and ALS transport of sick kids from newborn to young adult. We have a third one assigned to Swedish that is designed for NICU patients and has a special stretcher with its own Isolette.

I never have trouble hearing in the back of my rig. If you ever been in a Mercedes Sprinter, they are diesel but they are no louder than a standard car. I have no trouble hearing in them.

[MariB]

Actually, I work for a volly squad with a very small stipend lol. So no, you don't want to work here if you want to support a family, that is for sure.

Those EMTs who think having a high end stethoscope is cool won't think it is cool when they lose it or break it. I have to constantly check for it when I have it because I can't afford to just replace it. I was using the one from our second ambulance on test nights, but once sdwe went to breathsounds, I ccouldn't take it 2 to 3 evenings a week. I replaced it with mine which was OK but not that frequently.

Stethoscopes can run hundreds and hundreds of dollars. So a $50 one would be considered low end for some. Not for most EMTs though.

I bout a $75 littmann at first after using the tinker toy quality ones in class thinking a better one would help. I knew I had hearing issues since teen years and after a few tries at a bp, an instructor found his with a cuff on, pit it in my ears and said "Hear that loud thump? That's what you're looking for" I gritted my teeth, jammed the ear pieces as hard in my ears as I could and couldn't even make out a sound . He asked me if I ever had my hearing tested and I said I had and it wasn't the best, but I didn't feel it qualified for hearing aids since it didn't disrupt my day to day life. I for a fewminutes felt my EMT days would never happen

The lead instructor came over and knew I was having a hard time, he then inflated the cuff until the pulse was strong, put his stethoscope in my ears and asked if I could hear it. I did. I had thought I wasn't putting it on the right spot, or just wasn't getting it. Well he told me he was also hard of hearing and had a master cardiology stethoscope. I took several after that and was able to obtain a bp each time.

I looked around for a few days online and was let down. I couldn't pay for a stethoscope like that for a volly position.

Within days one came in the mail, from Santa

Sorry for the typos, on my phone and trying to correct them is causing a scroll issue

[scubanurse]

There's a guy in my nursing class who uses one d/t hearing loss from the Air Force. Other cheaper options is look for a stethoscope that has a wide tube and a shorter tube. The less tubing it has between the diaphragm and the ear pieces, the better.

ETA: I have this one http://www.allheart.com/3m-littmann-stethoscope/p/littmannlwt/ and love it. I'm on a tele floor right now and have to auscultate heart sounds constantly and never have an issue with this one.

Edited April 10, 2013 by Kate_826

[DwayneEMTP]

Yeah, well, I paid $200+ just because I thought that it looked cool...And it friggin' did! Don't you judge me!

I still have it, it still looks brand new, weighs about 6lbs, so if you give me trouble I'll bludgeon you to death with it...I am convinced that my stethoscope allows me to hear things that non other does...but it's possible, if only slightly, that that's bullshit.

http://www.littmann.com/wps/portal/3M/en_US/3M-Littmann/stethoscope/stethoscope-catalog/catalog/~/3M-Littmann-Cardiology-S-T-C-soft-touch-chestpiece-Stethoscope-Navy-Blue-Tube-27-inch-4473?N=5002728+5932256+4294958406&rt=d

But, for the record, that's the one that I have...

[MariB]

http://www.littmann.com/wps/portal/3M/en_US/3M-Littmann/stethoscope/stethoscope-catalog/catalog/~/3M-Littmann-Master-Cardiology-Stethoscope-Burgundy-Tube-27-inch-2163?N=5932256+4294958428&rt=d

This is mine.

[BAYAMedic]

Now that the original thread has derailed to a discussion on equipment, I will repeat what one of our old timers used to point out. The most important part of the stethoscope is that part between the earpieces. I would venture to say that a RT could hear abnormal lung sounds with a 3 dollar Sprague that a paramedic couldn't hear with a Master ultra cardiology flux capacitor equipped Pittman super jet with the gold plating. That being said I am glad Mari has found a way to adapt and function through better equipment choices. I usually palp the first one, auscultate the second and palp the third and beyond provided the numbers aren't changing.

BayaMedic