How do you want to be known as a Paramedic/EMT?
A. Reliable
B. Frequently wrong
According to a recent article in JEMS, Ditch the Machine to Improve Accuracy in Blood Pressure Measurement and Diagnostics, "automated blood pressure readings are frequently inaccurate."
Is this a surprise to anyone?
Yet, many of us continue to relay on automated BP cuffs to direct our clinical actions.
In a March 2016 article in the Journal of Clinical and Diagnostic Research, Which is More Accurate in Measuring the Blood Pressure? A Digital or an Aneroid Sphygmomanometer:, digital devices:
- should be used with caution, doubt and suspicion
- are not up to standard
- (can cause many people to be) wrongly or misdiagnosed
- may prove disastrous
Powerful words.
The JEMS article points out that even the manual for the Physio-Control Lifepack 15 contains this warning:
"shock may result in a blood pressure waveform that has a low amplitude, making it difficult for the monitor to accurately determine the systolic and diastolic pressures."
Got that. Your Lifepack 15 is not capable of providing reliable blood pressures if your patient is in shock.
Cardiogenic shock
Hypovolemic shock
Anaphylactic shock
Septic shock
Neurogenic shock
Your machine BP is unreliable when addressing these conditions. It is frequently wrong.
How are you going to make clinical decisions with bad data?
You need to take manual blood pressures.
As an EMS Coordinator, I see run forms with blood pressures like these:
158/71
210/190
143/84
95/87
170/119
All for the same patient. With no explanation.
As a paramedic, I have had my patient in afib brought into a level one medical room because the triage BP machine said my patient had a blood pressure of 79/40. Why are we in here? the doctor asked as he looked at my calm, warm, dry patient.
Because the triage system at this hospital relies on digital blood pressures.
Don't relay on machines to take a blood pressure in patients with atrial fibrillation.
Here are my guidelines:
- Make your first blood pressure manual
- Treat your machine pressures as an inexperienced partner
- Before making a critical clinical decision, take another manual pressure.
Make certain you know how to take a proper blood pressure.
Here are some good articles to help us improve our manual blood pressures:
Taking a Manual Blood Pressure: Techniques & Pitfalls
Blood pressure reading tips and tricks for EMS
I get it. It is hard and nearly impossible sometimes in EMS to obtain optimal conditions for taking a blood pressure.
Just know that the blood pressure you obtain under those impossible conditions (using short cuts) may not be accurate.
Don't let inaccurate and unreliable readings cloud your clinical judgement.
Take a manual, and if you can't hear, palpate a blood pressure.
