BP not detectable via manual cuff

[milkpumba]

Just got home from the weirdest shift I've had ever. I work in a long term care facility and one of my patients has been presenting with signs of dehydration. Yesterday, this same patient had an infusion of 1000ml NS bolus as per the doctor's orders. So today, I tried to check her BP but couldn't get a reading with a manual or electronic one. I informed the physician and received orders to transfer the patient to emerg. When EMS came, they were able to get a reading via their own electronic cuff. It was 130/79. I felt so stupid at the time LOL. But they also tried to take the BP manually and couldn't hear anything. In the end the physician and family decided to still send her to emerg. This is a first time for me, what are you're thoughts??

[SleeepyRN]

I am baffled as to why, but this happens to me occasionally. And I KNOW how to take a manual BP. So I just don't get it.

[VANurse2010]

Checks the radial and brachial pulses and get an estimate of systolic by the palpation method (there are plenty of videos on youtube how to do this). That's better than nothing, and can help you confirm your findings.

[Ruger8mm]

Checks the radial and brachial pulses and get an estimate of systolic by the palpation method (there are plenty of videos on youtube how to do this). That's better than nothing, and can help you confirm your findings.

^this.

[akulahawkRN, ADN, RN, EMT-P]

Pretty much the above. When you run into this problem, you must palpate the radial and brachial pulses. This becomes very important in a second or two... By establishing this, you now know exactly where to put the stethoscope head for maximum chances of hearing the right sounds. If by chance you don't hear anything (entirely possible) you then know the patient has a pulse that you can palpate and can therefore obtain a palpated BP. Remember, legally 130/P is completely valid. You just have to note that you were unable to auscultate a BP and therefore had to palpate one. If you were unable to palpate either pulse, then the patient is having a pretty severe circulatory problem... the BP may be 130/88 (or whatever) but if there's no palpable circulation to the limbs, something very bad is happening... think severe shunting and the body is likely sacrificing limbs for survival of the core.

I've been a Paramedic for a while and I'm pretty good at auscultation while moving. I've had to go to palpated BPs only a hundred times or so over the thousands of times I've taken vital signs... all manually by the way. There's only been a few times I've been only able to palpate a carotid or femoral pulse... and those times I tend to get very, very worried about the patient and I begin doing many things very fast.

[CrunchRN, ADN, RN]

Try raising their arm with their hand resting on your shoulder. That often makes it so you can hear it.

[morte, LPN, LVN]

make sure the arm is fully extended at the elbow.