Recently I have been taking 90% of my blood pressures with an automated cuff off of a LifePak 12. Cool, right ? Not really. You see up until now, all my blood pressures have been done manually with a cuff and stethoscope. Now some would argue that the “convenience” and “accuracy” of this technology is an asset to modern Pre-Hospital care. And that I should get with the times. (I’m young and only 4 1/2 years in… I’m with the times)
To be honest, I don’t like it. And I don’t like what its training our Paramedics and EMT’s to do. And that is to play the monitor like a penny slot in Reno. Before I get into that, I’ll highlight the pros of an auto BP cuff, to which there are some.
First: Yes, it is convenient. And who could argue with data storage, and the ability to transmit that data to the ER or an e-PCR… That’s about it. What I see are providers doing their assessments, and when the auto PB pops up its reading, their is a moment of contemplation. The questions is do i like this Blood Pressure? Or, Do these numbers make sense? sometimes there is even an exchange among care givers that goes something like: “you ok with that?… sure” or “you like that one?… nah, try it again”.
So what happens if you don’t like the first BP? take it again. How about the second? No? well we’ll try it one more time. So now after 3-5 minutes, you have 3 different BPs and what?
There are many factors that can interfere with an Auto Cuffs reading. Things like: A moving ambulance. A moving patient. An incorrectly sized cuff. A patient that is especially Hypo or Hypertensive, and so on. Yes, movement of the patient and the ambulance can disturb the process of taking a manual BP, but by holding the patients arm, it allows you to support and stabilize the arm, while also discouraging the patient from moving it.
The deal is, when I take a manual BP, and its 230/110, I know it is because I heard the pulse at 230, saw the needle bounce at 230, and followed it down to 110. Same goes for 88/60. I saw it, heard it, felt it. I find another advantage to manual BPs, is that you can assess skin signs, respiratory effort, and you can hear and feel the strength and rhythm of the pulse. If you allow it, a manual BP can tell you a lot about the cardiovascular status of your patient.
Now I’m not calming that my ears, or anyone else are the best in the world. And of course there are times when you just cant hear anything, and a few other situations when an Auto BP cuff can help, but generally, I prefer a manual. In the end it all comes down to a good assessment , and an accurate Blood Pressure is a major piece of that assessment.
Do good, and treat well.
