Blood Pressure

Medic/Nurse, BSN, RN · May 19, 2006

Narrowing Pulse Pressure.

Can be BAD, BAD, BAD.

In the presence of trauma mechanism, decrease in BP overall, increase then decrease in HR (possibly), muffled heart sounds, JVD, low gain on ECG. You have most likely cardiac tamponade. BAD.

Could be a few other things, but that is the first one that came to mind.

Keep on Learning, someone's life may some day depend on it!

Oh, what was the patients clinical course - numbers aren't very meaningful without clinical correlation. :)

shoover · May 19, 2006

Thank you. I am not sure what you mean by "patients clinical course - numbers aren't very meaningful without clinical correlation. :)"

Trauma Columnist · May 19, 2006

You have to look at the overall patient's condition: level of consciousness, mechanism of injury, pre-existing conditions, age, general health. It isn't wise to rely on numbers (like vital signs or lab values) to solely guide your care of the patient.

emtb2rn, BSN, RN, EMT-B · May 19, 2006

Thank you. I am not sure what you mean by "patients clinical course - numbers aren't very meaningful without clinical correlation. :)"

I believe this refers to the treatment the patient received (and how they responded to it) during the period the BPs were taken. BTW, what was the MOI?

shoover · May 19, 2006

That I understand I was just wondering what It is called when it does happen.

shoover · May 19, 2006

oh I dont know. I am just after what it is called when the numbers get close.

emtb2rn, BSN, RN, EMT-B · May 19, 2006

oh I dont know. I am just after what it is called when the numbers get close.

Just what NREMT-P/RN said, "Narrowing Pulse Pressure".

Medic/Nurse, BSN, RN · May 19, 2006

Clinical course - short answer - how did the patient do?

I guess I was a bit curious by a patient that was being "trended" with those numbers falling like that. I think my "trend" would have been to be less concerned with the number - and a tad bit more focused on

1. Is the patient rapidly getting worse?

2. Why aren't "we" doing something about that?

If the patient had no significant etiology for the "numbers", they don't mean too much. (Inflation/equipment error?)

Also, I would like to have known, specifically, with regard to situation that you describe:

Trauma patients mechanism?

Presenting complaint? Signs, symptoms? Pertinent negatives?

Age? History?

On-going assessment & diagnostic findings?

Final diagnosis and disposition?

If this was a real trauma patient with significant injury - those numbers would be very alarming. Could serve as learning experience for other forum members. :idea:

emtb2rn, BSN, RN, EMT-B · May 19, 2006

Clinical course - short answer - how did the patient do?
...I think my "trend" would have been to be less concerned with the number - and a tad bit more focused on
1. Is the patient rapidly getting worse?
2. Why aren't "we" doing something about that?...

Treat the patient, not the monitor.... :)

cardiacRN2006, ADN, RN · May 19, 2006

Treat the patient, not the monitor.... :)

Exactly! My mom is an ER nurse, and the one thing she taught me about nursing was this: always look at your patient when you walk in the room. How do they look? Their color, facial expressions their posture--all that. Eyeball your pt. Do your numbers match what you are seeing?

Of course, people are capable of incredible compensation, so just because they look good doesn't mean that they aren't sick!