Palpating blood pressures?
- 0Feb 10, '08 by DuflinkkaHello all!
Okay, so yesterday my friend was orienting a new nurse. She asked if VS were completed for one particular resident. This client's BPs are always low, as in 90/60 for example, and they can be very difficult to hear. The new nurse replied that she had "palpated the blood pressure." No scope, no cuff. My question is this: Has anyone else ever heard of palpating a BP? I know you can somewhat palpate the brachial artery to properly place the scope, but I have never hear of anyone having this skill.
- 5Feb 10, '08 by Christie RN2006We are taught to do this in the field if there is too much background noise. What you do is place the BP cuff on, find the radial pulse, blow up the BP cuff like normal and palpate for the radial pulse until you feel it come back. Palpating a BP works, but it isn't the most accurate (it can be off by around 10mmHg). You can only get get the systolic number if you use palpation and it is generally written like 90/palpation. A better way to get BPs on patients that are hard to hear is by using a dopplar. You place the dopplar over the brachial artery, blow the BP cuff up and listen for the pulse to come back.
You have to use a cuff to get a BP. The only way to get a BP without a cuff is if the patient has an A-line.
- 1Feb 10, '08 by snowfreezeA palpated pulse is systolic over palp as you do not get an acurate diastolic. exp.(110/P)
A field palpated pressure in a trauma patient is usually 90 at radial, 60 at brachial and 40 at carotid, these are systolic pressures these are pressures estimated from palpable pulses.
In emergency situations in hospital when I have many goals I usually go for the palpated field pulse.
- 3Feb 10, '08 by XB9S GuideI have been taught and teach to palpate BP using the radial pulse (with a cuff) pre-hospital when you are unable to hear due to background noise.
If this is not possible of if you are struggling to hear or feel then I teach:
If there is a radial pulse present then you have a systolic greater than 80
Brachial greater than 70
Carotid is greater than 60 mmhg (this is what is taught in PHTLS)
- 2Feb 10, '08 by getoveritI have heard the same thing in BTLS/PHTLS, we had this discussion at work and one of the docs said that it was more accurately a reflection of the MAP to produce a pulse at the different sites. the patient had a systolic BP <70 but his radial pulse was still easily palpable. We had a femoral A-line in for the pressures and it was transduced properly.
But like ChristieRN2006 posted, in the field we use palpated pressures a lot for our initial pressure. If we have a severely traumatized patient, I don't really care on the initial assessment what the actual systolic and diastolic bp is (e.g. thready radial vs strong carotid or no radial and thready carotid), I want to know the presence and quality of the pulses while we address the airway and breathing, try to control any bleed and establish some vascular access. Once we feel the ABCs are managed, then I"ll hook them up to the monitor and get a pressure.
What does anyone else think?