I came across this article on JEMS where a study was done on the differences between a manual and an automatic B/P reading and it reminded me of a conversation I had recently with a paramedic. In my county we use the Lifepak 12, ours are set up to be a BLS and an ALS tool as we can use it for pulse ox, B/P, capnography, Congreve, ECG and 12 lead ECG and as our AED. The paramedic and I were discussing the fact that most providers rely only on the information they obtain through their Lifepak now. We have both witnessed the look of panic on the newer members faces when the Lifepak beeps, alerting them that the pulse ox is not found because they put that on the same arm as the B/P cuff. When I first started I remember working with medics who insisted on at least one manual B/P, when going through my Enhanced class last year I had a few teachers who still felt the same way. Most people in my class rolled their eyes at the thought of taking a manual B/P, including myself, but after reading this article it definitely makes me take a step back.
Since the contributors and readers of this blog cover many states and protocols I figured we could get a good mix of opinions on this subject. So tell us, do you prefer only manual, only automatic, or a mixture of both?
P.S., When doing spell check on EMS related blogs you receive some interesting "suggestions." Instead of "capnography" spell check suggested that I use "pornography." Our Lifepak doesn't provide that, maybe it's an upgrade option?
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Crossing Fingers
10 years ago
13 comments:
We use LP 12s where I work. We have all the bells and whistles that you mentioned including the automatic BPs. I personally don't like the automatic BP, I prefer taking manuals, but they do offer a nice convenience. Our protocols state that the first and last BP needs to be manual, but the in-between BPS can be automatic. I find this acceptable. I also encourage the new medics to double check manual BPs whenever the automatic gives a funny number like 230/160. Our automatic BPs seem to also give a lot of errors like "too much motion" or "air leak." I thin they are making us lazy and allowing the less competent medics to miss important ACCURATE trending patterns.
-Zumstin
Manual BPs at the roadside are virtually impossible because of noise, in the same way that listening to the chest is impossible. In those circumstances automatic BP is a must. However, we only use automatic BPs in A&E as well, unless there is some very abnormal result.
Had to fix the spelling.
We currently only have manual BP where I work (Tasmania, Australia).
This is most likely because we have base level cardiac monitors and Auto BP would have been an added option / cost !
All machines are an aid to clinical assessment. I really don't like seeing colleagues relying only on what the machine tells them.
If the machine says the bp is in their boots and their sats are <50 but they are a good colour and are fully perfused and orientated then trust your eyes!
I would rather take a manual where possible, other than wait for the lifepak12 to give me a reading I don't believe, then have to check it manually anyway.
I am anal about getting manual BP's, and I drill that into my EMTs' brain. Nothing beats a manual BP. Just like one of my biggest pet peeves is when someone puts on a pulse ox and gives me a pulse reading from it. NOTHING beats feeling for a pulse. A pulse ox can't give you regularity and strength.
There is my rant...
We have the LP12s with auto BP. I don't like them becasue they are waaaay too sensitive. I have noticed that just the movement of the tubing causes an inaccurate reading. I have also noticed that they are typically 10-20 mmHg higher than a manual BP. Our medical director wants at least the first BP to be a manual one, but, people still want to use technology over skill.
As an FTO I require all of my newbies to get manual BPs on all patients. For a 'critical' patient requiring 'skills' I will let them place the auto cuff, but I still want them to get manual readings, and I keep a watch on them to make sure they do.
I usually hide the SPO2 cable as well, because too many of my brethren depend waaaay too much on SPO2 rather than real respiratory assessment.
I would rather just always use the manual method, because you can tell so much more about your patient by actually having to place hands on them...
I love having the ability to use the LP12 NIBP, it's a huge help especially if in back by yourself giving out nitro just set it to q 5 and it's great also helps you space the doses between and even have on the printout of vitals a good record. Or when you have a heavy hands on call it's amazing just put it on get a baseline, don't have to worry about having someone taking up space getting a bp when can do something else.
Pros / cons. Can read artificially high on bumpy road etc. Again depends on your school of thought worked with some medics where everyone got manual baseline others on situation dependent ie unexpected high low or diff trending.
Service I work now just has manual, they say it's to keep up skills but think it's more a costing issue. I hate it since it means on a serious pt I'm wasting time getting bps
Studys for manual bps show diff between 20-30 mmHg just between people. Due to hearing etc, also know a fair few medics who can only get over palp in the back due to hearing
You notice way too much from auscultating a BP manually about rhythm, strength, etc to not do so. It may take a little longer, and distract you from treating the patient, but the wealth of information you can gather is invaluable.
But then, during transport, hitting the NIBP button is so much easier than repeatedly doing it manually. And with a baseline "accurate" manual reading, you only need to start worrying if the auto reading changes much from there, when you can redo it manually.
I worked in a Level one trauma center for awhile. The trauma surgeons insisted that the first BP taken upon arrival of an activation was manula. Often when the pressure was low, manual bps would be taken over what the autocuff said. I have noticed this as well with people new to the emergency medicine field. Thanks for the reference to the article.
I pretty much agree with everyone on here, I like to have a bsaeline vital that I heard with my own two ears, after that Im comfortable with NIBP, especially if its a busy hands-on call and I dont have an extra set of hands.
We have the new Zolls. I think they're great but I still insist that the first BP be taken manually. After that, if the patient is hemodynamically stable, I'll use the monitor.
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