Does Anyone Agree?

[Timmy]

" It is important to recognise that Blood Pressures are only one sign assessed in a

complete patient assessment and therefore, used in isolation provides little indication of

the patient’s condition or time critically. A complete and thorough assessment, including

a full set of vital signs survey should be completed on all patients where a Casualty

Report Form is completed. Blood Pressure assessment is one part of an overall

perfusion status and should be considered in the context of the patient’s presentation and

other observation and information, including history. "

[Michael]

Unless this is trick question or you feel like counting to 9,999, you might want to change the subject-header to "Does Anyone Disagree?"

[emtsenator]

Tim,

2 months ago my medical control was suspended because the BP for my patient was 80/50. The only other symptom possibly indicative of hypotension she exhibited was a headache. She also had drank alcohol earlier that day, it was hot and humid with no A/C, and her husband was very annoying to her. On scene she appeared stable- normal skin color, and able to recall information (with time- she had a substance abuse history which didn't help). While she was definitly a priority patient, her hypotension wasn't the primary reason I was concerned with. I was concerned about the longer- evolving renal failure.

Where did you get this definition?

[Timmy]

Where did you get this definition?

I was told this by 2 try hard’s who call them selves paramedics.

Just wondering if it was true? What peoples thoughts were?

[Ridryder 911]

I fail to see the question :?:

R/r 911

[Timmy]

They also said “The assessment of Blood Pressure has little impact on patient treatment”

The first thing paramedics do as soon as they treat a patient is take a BP.

I’ve also had paramedics say “its important to keep monitoring the patients BP”

I’m Confused, who do I believe?? :?

[becksdad]

Blood pressure alone has very little use. It must be used in conjunction with as many other assessments as possible to arrive at any kind of intelligent decision regarding patient conditions and or treatments. For example, what does a BP of 90/60 indicate? By itself it indicates nothing. It may be perfectly normal for certain people. It may be indicative of potentially serious conditions in others.

Lets take 3 different people in similar situations and see how that BP of 90/60 will mean different things when used in conjunction with other diagnostic tools and histories. 3 people are involved in a single MVC. In the first vehicle is a 40 y.o female, and her mother, who is 72 y.o. Both of these people were front seat passengers who were restrained by lap & shoulder belts, and airbags deployed in the front impact collision. The third person, in the other vehicle, is a 46 y.o. male, who was unrestrained, and no airbags deployed (also front impact). All 3 people have blood pressures of 90/60.

The 2 women from the first vehicle have some superficial abrasions from airbag deployment, and both complain of some pain along clavicles where seatbelts restrained them. The younger of the 2 women has a HR of 62, regular in rhythm, and respiratory rate of 16. She explains that she is a fitness buff, and runs daily in addition to other workouts. Her BP of 90/60 and the relatively low resting HR of 62 can be quite normal for a very athletic younger woman. She has no other complaints, and does not desire any medical attention.

This woman's mother, her passenger, with the same BP, has an irregular pulse of 100, and an unlabored respiratory rate of 18. She explains that she was recently diagnosed with A-fib, thus her irregular HR, and she also claims that her BP is within normal for her. Again, this woman has no other complaints, and does not wish medical attention. Head to toe trauma assessments on both these women indicate no further evidence of injury beyond the superficial ones described above.

The 46 y.o. male in the other vehicle managed to climb out of his vehicle, but is now laying in grass near the roadway. As you approach, you notice that the windshield of his vehicle is starred in front of the drivers seat, and the steering wheel is bent. This patient is fairly large, maybe 130 kilo's, and he is concious, complaining of severe pain in right upper quadrant of abdomen, as well as lower rib cage. Patient also has a large laceration to the forehead, presumably from striking the windshield. During head to toe, you note crepitus along several ribs lower right side of chest, a tender, rigid abdomen, with severe pain to palpation. Upper right quadrant is beginning to show bruising also. This patients HR is 130, respirations at 28, and his skin is cool and clammy.

Quite a difference in patients, and the blood pressure was significant in only one of them. BP was found to be normal for the first 2 patients when taken as part of assessments that included other signs, as well as histories. The third patient, however, is likely in a serious condition. I'm thinking maybe lacerated liver. several broken ribs, and a head lac. The head lac is probably the least of his problems, since he may rapidly bleed out from the liver injury. The sustained rapid HR and elevated respirations, combined with a blood pressure that seems VERY low for a 130 kilogram male all paint a picture of shock.

So like anything else, the more information you can obtain about any patient, the more accurate your impression is likely to be. That is why SAMPLE is important, as well as full sets of vital signs. Good history taking is imperative because the answers to one question will lead you to ask the next questions, which hopefully lead you to a more focused history and exam. But don't ever rely on only one source of information to come to any conclusion about patients.

[Timmy]

Becksdad: Thanks for that mate you made it really easy to understand!

It’s hard when your only learning and you have different people saying different things.

[JPINFV]

There is no one measure of a patient's condition. Sometimes I'll grab a BP first thing on a patient. Sometimes I'll take it half way through my exam/interview. The patient's and symptoms of a 70 y/o M complaining of "chest pain 10/10" can tell you much more then a set of V/S will (CP man in this case has a hx of GERD, and the pain was midline, intermittent and existed only when he had hiccups. Denied pain when there wasn't any hiccups. Denied numbness or pain radiation. Skin signs were normal).

[Just Plain Ruff]

Maybe a extension of this topic would be "Palpated blood pressure, good thing or bad thing?"