Palp pressure traumatic hypotension

[dudemursestudent]

So I'm in nursing school and i've been an EMT for a while, we always talk that in general the systolic BP is at least 90 if you can palp a radial pulse. But in trauma and internal hemorrhage you want to keep the systolic low to slow bleeding, sometimes 70-80ish at that point you might not feel a radial pulse, how to you get a manual bp when it is too noisy to auscultate (like it always is in the field or ER)? or do you just slap on the NIBP and just hope for the best?

[FOCKER0014]

For starters..I have worked in a Surgical Trauma ICU for 6 years and was a medic for 4..I have NEVER had an instance where the MD's, Nurses, PA's or any other provider was comfortable with any sort of hypotension due hemmoraghe or internal bleeding!!!!! Hypotension at the point to lose a radial pulse is usually one step away from the patient coding and it's insane that any physician or nurse would be comfortable with that. Induced hypotension is used in the OR but rather sparingly from what I hear from the CRNA's at my hospital. Also hypotension is allowed in patients where VOLUME is NOT a concern....

To answer your question though...You are right, there are times when a manual is difficult to obtain in the field due to being loud on the truck however the ER is a "controlled" environment and there should NEVER be a problem with obtaining a manual UNLESS the patient just doesn't have a BP to get. Manual BP is the standard for when a NIBP cannot be obtained though at the LEVEL 1 i work at.

[ShaunES]

Any trauma like that should score an art-line anyway, so the noise of a trauma bay is irrelevant after that goes in (usually one of the first interventions).

[aCRNAhopeful]

I'm no trauma nurse and I've never been an EMT either but I also think it's ridiculous to allow hypotension in a hypovolemic patient. The whole point is to keep the person alive not to just stop the bleeding. With that logic, why not just stop their heart for like 2 minutes to get some hemostasis then just restart it afterwards?

[meandragonbrett]

Here are a few articles on Permissive Hypotension in the trauma patient.

www.trauma.org

[dudemursestudent]

Sorry i didn't make my self clear, i'm talking about working in the prehospital environment, when transporting a pt to a hospital with suspected internal bleeding and administering iV fluids you do not want to raise the blood pressure too high so that the pt bleeds out before getting to the OR. its just when everything is moving in the truck and your trying to get a pressure sometimes it's hard to palp the radial, and not always sure its there. like is pulsus paradoxus where the intrathoracic pressure of breathing can stop a radial from being palped. This is not a place that i want a pt to be in but if your trying to get a pressure is there anouther way or does the pt just not have one you can get.

I checked out the Trauma.org link and that is the stuff i was talking about. just looking for some tips in how to carry out the trauma protocols and keep the pt beating. also Focker0014 i think i understand that if there isn't a pressure to get than you just can't get it. (without an arterial line)

[IloveTraumaNursing]

meandragonbrett, thanks for the link to trauma.org. It was very valuable in this discussion.

[aCRNAhopeful]

I stand corrected. That seems utterly insane but i guess it works. I would be wondering if my pt was 2 seconds away from arresting or if they had a pressure of 80/60 and were doing ok.

[FOCKER0014]

Good articles however pretty dated.....2002 most of them...

[rgroyer1RNBSN, BSN, RN]

I agree with ShaunES I have been a trauma and sicu nurse for quite awhile now and any critical care patient at my level ! trauma center I work at, (Barnes) in ST.Louis, they score an ART Line right away by the doc, pa, or np. And if you have an art line you dont have to worry about getting a pressure.