Automated BP cuffs

[PRPGfirerescuetech]

Im curious, how many of you all use the automated BP cuffs...

If you do...is it your primary, or secondary BP. Do you check it against a manual reading?

If not, why not?

[AZCEP]

It has been a while since I've had to rely on one, so I can only hope the technology has gotten better. My experience with them has been that they are too inaccurate to rely on. For all the attention that motion artifact gets with cardiac monitors, it is just as bad for NIBP units.

If the patient is critical, and I don't have another set of hands to help, then the trending that they do is useful. Otherwise, I don't care for them.

[Ace844]

It has been a while since I've had to rely on one, so I can only hope the technology has gotten better. My experience with them has been that they are too inaccurate to rely on. For all the attention that motion artifact gets with cardiac monitors, it is just as bad for NIBP units.

If the patient is critical, and I don't have another set of hands to help, then the trending that they do is useful. Otherwise, I don't care for them.

"PRPG,"

I agree with "AZCEP" and will add that they decalibrate easily, as noted are notoriously inaccurate, and not worth the space they take up...as such my choice wasn't listed in your poll so I didn't respond....

[andrean678]

I do not agree with them for BLS providers. In an ALS setting they are helpful if the medic is by himself, and has tons to do he/she can take BP every 5 min. off their list of things to do. For BLS, I think some providers would over use them, and not be able to auscultate a BP on their own.

[schemp001]

Well what is a bp, anyway. It's just a measure of whats going on at that time, right then. Accurate b.p. trends is what you are going for. The whole 6 years I've done this job as a medic I have yet to see an EMT take B.P. measurements every five, or ten, or any set interval of time. It's usually done when they remember whenever to do it, or asked to get another one. There is not much for a basic to do when in the back when a medic is treating. most of them write their charts on the way in to the ED. Might as well do the one part that is your job to do. Now to say that the technology in the machine is more accurate than you is a bit much. There is tons of literature out there that says they are in fact more accurate. How many triage nurses take a manual BP when the triage a patient. Almost all the beds in the ED use machines to trend, and doctors count on them to be accurate. Its not that the staff is lazy to take one, but they are accurate. Now they are mechanical, and true stuff breaks, that's why you carry the manual ones right. I challenge you to use a machine, than compare the results to what you get through auscultation, I bet the number of times its totally different, is very minimal.

[ladyfirefighter36]

we have one on board, but it is used as secondary, most of the time. All trauma calls must be done manually first, then the automatic can be attached, if you are really busy with other interventions. We may use it once in a while on a patient where the bp is hard to get.

[Guest]

I do not agree with them for BLS providers. In an ALS setting they are helpful if the medic is by himself, and has tons to do he/she can take BP every 5 min. off their list of things to do. For BLS, I think some providers would over use them, and not be able to auscultate a BP on their own.

I work BLS/ALS calls....It doesn't matter if you are ALS it all comes down to the basics first. When taking a BP ALS shouldn't rely on machines to calculate an accurate BP anyway. As secondary...sure. BTW why don't you agree with it for a BLS provider? I'am on all my calls by myself and there is ton's for one BLS provider to have to do. Not that I would solely rely on it. Just like the pulse ox.....I use it....but I don't rely on it. Mainly just to check the stats I'm getting with what the machine is saying.

[andrean678]

I work BLS/ALS calls....It doesn't matter if you are ALS it all comes down to the basics first. When taking a BP ALS shouldn't rely on machines to calculate an accurate BP anyway. As secondary...sure. BTW why don't you agree with it for a BLS provider? I'am on all my calls by myself and there is ton's for one BLS provider to have to do. Not that I would solely rely on it. Just like the pulse ox.....I use it....but I don't rely on it. Mainly just to check the stats I'm getting with what the machine is saying.

Ok. I am assuming that you work PB as a basic. I also work PB as a basic. My question to you is how much stuff do you have to do working PB on a basic call that keeps you SOOOOO busy that you do not have enough time to do a full set of vitals once every 10 or 15 minutes? I am on all the calls by myself, and I usually have 2 sets of vitals and most if not all of my paperwork done by the time I get to the hospital. BTW, right now I work in a town that is about 15 minutes from the hospital. Before you say it, I also have worked in a system where I was 5 minutes from the hospital. I just do not see the need for BLS to have to use automatic BP cuffs.

No, I do not think ALS should use this as their sole form of getting a BP. At least one should be auscultated.

[Guest]

I usually get at least 4 set of vitals manually before we get to the ER...more on a trauma pt. I don't even use an automatic BP cuff. Depending on the call I may not get my report finished until the trip back to the station. Most of our calls are trauma and there is a lot more to do on a trauma pt. Bleed control, splinting. A lot lately has been opening and maintaining an airway. BLS providers...at least here...have just as much if not more to do then ALS. I'm considering my area...ALS is over 30 miles away and so is our trauma centers. But since your ER's are only 5 minutes away I can understand your point for your area. Totally different circumstances in your pre-hospital care then in mine. I do however, think that the "machine's" should only be used as a secondary evaluation of monitoring vitals. Manually should always be first. ALS or not. But I also think that the issue of BLS providers ..{again in my area} being considered incapable of using them is bogus. You'd have to run in a rural area for awhile to even understand how so different things are done...then in a city where ALS and trauma centers are easily accessible.

[Ace844]

Hi All,

Here's what a recent piece of literature has to say on this....

http://journalsonline.tandf.co.uk/(qsbpkv5...lts,1:112492,1;

NEAR-CONTINUOUS, NONINVASIVE BLOOD PRESSURE MONITORING IN THE OUT-OF-HOSPITAL SETTING

Stephen H. Thomas A1, A2, Greg Winsor A1, Peter Pang A2, Suzanne K. Wedel A1, A3, Blair Parry A2

A1 Boston MedFlight, Boston, Massachusetts

A2 Department of Emergency Services, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts

A3 Department of Surgery, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts

Abstract:

Objectives. This study was conducted to test out-of-hospital performance of a noninvasive radial artery tonometry device to assess blood pressure (BP), providing readings every 10–12 seconds. The primary objective was to determine the correlation between noninvasive BPs calculated with radial artery tonometry and standard oscillometric cuff methods. The secondary objective was to determine whether the difference observed between the two techniques was consistent over the range of BPs measured. Methods. This prospective trial enrolled adults transported by helicopter (n = 9 patients), fixed-wing airplane (n = 1), or ground vehicle (n = 10) of a single transport service. Patients had BP assessed simultaneously, by both standard automatic cuff and radial artery tonometry device, every 5 minutes. Data were assessed with correlation coefficients, and Bland-Altman techniques were utilized to assess for bias over the range of mean arterial pressures (MAPs) encountered. For all tests, p was set at 0.05. Results. No major problem with radial artery tonometry device field performance was noted. There were 139 pairs of MAP assessments in 20 patients. The correlation coefficient for the two assessment modalities was 0.96. Bland-Altman bias plot and Pitman's test (p = 0.11) revealed good correlation between the two assessment mechanisms over the entire range of MAPs (42 to 163 mm Hg) encountered in the study. Conclusion. The radial artery tonometry device provided MAP assessments that were highly correlated with readings from a standard oscillometric device. The radial artery tonometry device performed well in a variety of patient types and in multiple transport vehicles, and there was no sign that its performance was adversely affected by the out-of-hospital setting.

Hope this helps,

Ace844