Quote from rnmi2004
I work on a med-surg floor & the other day I had a pt who had a cardiology consult due to aortic stenosis. She went from being a stable GI bleed to very unstable. Our critical care team assessed her & decided she wasn't sick enough for the ICU.
We couldn't get a pressure in her left arm at all, either with the auto cuff or manually. The right arm I got a decent pressure manually -120/72. Throughout the night, it varied from oneteens/60's down as low as 108 systolic. I'm not sure what I should do in that situation - the doctor didn't seem very concerned, even when I reminded her of the pt's heart condition and that she was actively bleeding. Was I getting an artificially high reading?
What do you usually do when the pressures are unequal? No one I worked with that night seemed to have an answer for me, and what I've reasearched just says that there is a difference in the right & left extremities, not which one is the accurate one.
First off, the difference in the right/left arm comes from the anatomy. The left subclavian artery branches directly off the aortic arch, while on the right the brachiocephalic artery branches later into the right subclavian and the right carotid arteries, this can sometimes account for pressure differences between the arms.
When I have unequal pressures, I look carefully at the patient condition. Are they A&O x4 without any symptoms or are they unresponsive. Are there other symptoms such as tachycardia, dizziness, lightheadedness, syncope. If you are drawing serial HCTs are they trending down or stable?
The vitals you posted do show a widened pulse pressure, were IV fluids initiated? If so, did the pressure respond to the volume? Pressure response to volume could indicate hypovolemia and lend credence to a worry about an ustable GIB needing an ICU bed.