What to Do When You Cant Hear Anything During a Bp Reading
Updated February 11, 2015
Try these half-dozen tips to take some of the pressure off of getting a blood pressure
One of the things I'm nearly often asked past students and rookie EMT's is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"
My reply is usually to cup my hand backside 1 ear and shout, "What?"
Much to my chagrin, few of them accept the hint, but honestly, I'd rather bargain with those kids than the ones who take a pressure, drape the scope around their neck, and confidently announce, "120/80…"
… for every patient.
One-time, young, fat, thin, pink or pale, everybody has a suspiciously normal claret pressure that always ends with a zero. Just equally bad are those who hesitantly stammer, "Uhhhh… 135/79?"
My ears may suck, only my eyes are all the same pretty good, and endeavour equally I might, I've yet to be able to observe those odd-numbered markings on a sphygmomanometer gauge. Thus, I'm forced to conclude that my rookie either has preternaturally sharp hearing and eyesight, or he'southward pulling those numbers out of his rectum. Judging from the incertitude in their tone, I usually go with the latter.
Being a guy with a measurable hearing arrears in both ears – besides much shooting equally a kid without adequate ear protection – I've learned a few tricks over the years to allow me to hear what I need to hear in the back of the rig. Sometimes, when the sounds I'm listening for are in the high frequency range where most of my hearing loss is, I have to resort to things like assessing tactile fremitus, or rely on the ears of a trusted partner.
Luckily, Korotkoff sounds are low-frequency plenty that I tin still choice them out over the rumble of the road below my feet, but it takes a lot of practise and sometimes a few tricks to be able to distinguish the real stuff from the road dissonance. Hither'due south a few of the tricks I've learned:
1. Isolate the patient's arm from everything else.
When y'all wrap the cuff around his arm, cup your non-dominant paw under his elbow, and tuck his palm beneath your elbow. Elevator his arm off the mattress, stretcher runway, or whatever information technology'southward in contact with. If y'all like to lay the patient's arm across your lap while y'all auscultate a BP, elevator your anxiety onto tiptoes to minimize transmission of road racket through the soles of your feet.
two. Apply the bell of your stethoscope, non the diaphragm.
I spent 18 years in EMS without learning that trick, and information technology took a Stethoscopy For Dummies class from Bob Page for me to run across the light. The bell of your stethoscope works amend on those low-frequency sounds. Endeavor for yourself, and y'all'll see.
three. Apply a skillful stethoscope.
While you're on that initial gear-buying spree right after graduation from EMT schoolhouse, say no to the bound-loaded window dial, Swiss army knife trauma shears and the glove holster, and treat yourself to a prissy stethoscope instead. A few hundred bucks spent in the showtime volition pay a career's worth of dividends. And whatever 'scope you purchase, take off the stock diaphragm and supervene upon it with a disposable antimicrobial diaphragm. They're cleaner, safer for your patient, and they're much more acoustically sensitive.
iv. Turn your cuff upside down.
Yous know those hoses that bump annoyingly against the caput of your stethoscope? You can get them out of the way by turning the cuff upside down. It won't affect the accurateness of your findings, as long equally y'all make sure the avenue markers are yet lined up correctly.
5. Learn to palpate.
It'southward not optimal, just sometimes you just tin't hear a pressure. In all my time in Ems, I've only met i person that tin get an accurate systolic and diastolic pressure from palpation, only unless your name is Liz Hyde, you'll just accept to practise like the remainder of the states mere mortals and settle for a crude systolic pressure level.
six. Plow off all the crap in the dorsum of the rig.
Being spec'ed for use in Louisiana summers, our rigs are equipped with air conditioners that keep the module a comfortable 72 degrees – or at to the lowest degree that's the rumor. But nonetheless well they absurd or don't cool, hearing annihilation over them is like straining to hear the whispered words of a lover over an F5 tornado. Except in the case of blood pressures, you can't lip read, smile and nod.
If yous're one of those EMTs whose ears threaten to betray you when you lot need them most, endeavor some of these BP tricks. Hopefully, they'll have some of the pressure off of getting a pressure.
About the author
Kelly Grayson, NRP, CCP, is a disquisitional intendance paramedic in Louisiana. He has spent the past 24 years as a field paramedic, critical intendance transport paramedic, field supervisor and educator. He is president of the Louisiana Guild of EMS Educators and a board member of the LA Clan of Nationally Registered EMTs.
He has an Associate of Full general Studies degree from Louisiana State Academy at Eunice, Nunez Customs College. Kelly has been recognized as the 2016 Louisiana Paramedic of the Twelvemonth, 2002 Louisiana EMS Instructor of the Year and 2002 Louisiana AHA Regional Faculty of the Yr, and with the 2012 Maggie Award for Best Regularly Featured Spider web Column/Trade and the 2014 Folio Eddie Honor for Best Online Column.
He is a frequent EMS conference speaker and contributor to various European monetary system training texts, and is the author of the popular web log A Day In the Life of an Ambulance Commuter, "En Route: A Paramedic's Stories of Life, Death and Everything In Between," and "On Scene: More Stories of Life, Death and Everything In Betwixt." You tin can follow him on Twitter (@AmboDriver), Facebook, LinkedIn, or email him at kelly@ambulancedriverfiles.com. Kelly is a member of the EMS1 Editorial Informational Board.
Source: https://www.ems1.com/ems-products/medical-equipment/articles/blood-pressure-reading-tips-and-tricks-for-ems-Rfxcao87T4A3GKTY/
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