Blood Pressure Cuffs

[CrazyLadder]

Is anyone using automatic BP cuffs. Looking into possibly getting some for our MFRs. Any one brand or model better than another.
Comments please...

[dentedhead]

The only ones I am familiar with is the BP cuff that is part of the zoll defib/monitor.It is okay for a routine assesment and could be a little fussy during transport. IMHO I prefered the manual BP cuff for a thinking assessment IE WTF is wrong with this pt,but thats just me.In all honesty a BP is easy to take, its the ability to understand what it means is the important thing.

I know Brampton fire used to have stand alone auto cuffs maybe one of their guys could be more helpful.

Dentedhead

[Leafs Fan]

We tried the stand alone cuffs, they were not meant for field work. They appeared to be very unreliable giving horribly inaccurate readings. Any type of jostleing and it reads error. We find it faster and more accurate to just go the old fashioned way and use the stethascope and cluff. If it is too noisy we just go for the bp by palp.

We do use this oximeter (sp) thingy that goes on the index finger and gives us pulse rate and O2 sats and is very quick and seems accurate.

[Roadwarrior]

ditto what Leafs Fan said.....horribly inaccurate...

[dentedhead]

We tried the stand alone cuffs, they were not meant for field work. They appeared to be very unreliable giving horribly inaccurate readings. Any type of jostleing and it reads error. We find it faster and more accurate to just go the old fashioned way and use the stethascope and cluff. If it is too noisy we just go for the bp by palp.

We do use this oximeter (sp) thingy that goes on the index finger and gives us pulse rate and O2 sats and is very quick and seems accurate.

LF or anyone else using a pulseoximeter treat the pt and not the machine.You can have someone sating 90-100% but not perfusing worth a sh@#.If they look like they need O2 give it to them.

The alleged medics in my area are famous for this.Hmm their sats 98% so they are ok....while the pts pale and gasping for air.

Dentedhead

[colin911]

I know Brampton fire used to have stand alone auto cuffs maybe one of their guys could be more helpful.

Dentedhead
We just have the regular BP cuff ... nothing automated ... concern was that the fire trucks were too rough when travelling and the instrumentation could be comprimised. We asked for (and received) pediatric bp cuffs .... still waiting on the FAT arm bp cuff ... you know the ones that you couldn't even get a camper blanket around :). (but we don't have those ones yet)

[mutts252]

LF or anyone else using a pulseoximeter treat the pt and not the machine.You can have someone sating 90-100% but not perfusing worth a sh@#.If they look like they need O2 give it to them.

The alleged medics in my area are famous for this.Hmm their sats 98% so they are ok....while the pts pale and gasping for air.

Dentedhead

good point DH... it's all about using your head. then again, the pulse-ox can be a handy little tool when you can't figure out WTF is wrong with a pt, then see that their O2 is only in the 80's...

we had a young boy this summer just randomly keel over unconscious at his cottage... hooked him up and could see his O2 sat recovering nicely over the course of a few minutes. matched nicely with him 'feeling' better. ... pale as a ghost on arrival, getting some colour back in short order. O2 sat levels and BP are also handy to pass on to EMS when they arrive, they seem to appreciate it.

on the same call, we went to use our auto BP cuff... but the child cuff had been taken out of the med bag and put somewhere unknown on the truck, so we were back to the old fashioned way. worked like a charm. ... and yes, our auto cuff is suuuuper finnicky, too. for the most part... i'd go the old-school way. better to be really familiar with that, and good at it, than have to rely on an auto cuff to do your work for you (and be screwed if/when it ever doesn't work).

[FLASHOVER05]

Remember everyone... Automatics like Zolls are doomed to fail at some point... When it boils down to it it's gotta be old school... pull out the littman and the BP cuff and get those vitals... DH is right... treat your patient and not your diagnostic tools!

[firefighter26]

Sounds like the automatic ones don't work all that well. I have always believed that all the automatic this and automatic that's are nice to have, but when it comes down to it, it is the properly trained responder that saves people's lives regardless of what the automatic readings are saying. Just as in the Pulse-Ox, having a high count doesn't mean the PT can forgo O2 therapy. In fact, even with a high count a little O2 can still go a long long way.

As for BP, as a lowly first responder they didn't teach us that one. Gave us a brief overview of what it was and why it was important, but never gave us any direct training with it (nor was it on the list of equipment we are allowed to use). In the last 2 years, however, I have been trying to pick it up as another tool in the tool box. Only problem is that I have a damned hard time picking anything up with the stethoscope, even in ideal class room conditions. I usually end up resorting to the old school way of feeling for the pulse and keeping a close eye on the guage for movement. Any suggestions on what I might be doing wrong? Everyone says it is easy to do so I must be doing something wrong!!!!

[Red_Devil]

Yeah you gotta put the stethoscope ear buds actually in your ears to hear anything ;) try it i swear it works!

[PEMS17]

Sounds like the automatic ones don't work all that well. I have always believed that all the automatic this and automatic that's are nice to have, but when it comes down to it, it is the properly trained responder that saves people's lives regardless of what the automatic readings are saying. Just as in the Pulse-Ox, having a high count doesn't mean the PT can forgo O2 therapy. In fact, even with a high count a little O2 can still go a long long way.

As for BP, as a lowly first responder they didn't teach us that one. Gave us a brief overview of what it was and why it was important, but never gave us any direct training with it (nor was it on the list of equipment we are allowed to use). In the last 2 years, however, I have been trying to pick it up as another tool in the tool box. Only problem is that I have a damned hard time picking anything up with the stethoscope, even in ideal class room conditions. I usually end up resorting to the old school way of feeling for the pulse and keeping a close eye on the guage for movement. Any suggestions on what I might be doing wrong? Everyone says it is easy to do so I must be doing something wrong!!!!
To find out where to hear the pulse when doing a BP, learn to feel for the pulse in the ACF, helps you to landmark for stethoscope placement. Once you catch what you are listening for, you can take em on gravel roads. BP sounds are distinct from background noise. Also try different stets. Personally, I might as well put my ear to the arm if all I have is a Littman II stethoscope.
As for automated BP machines, provinicially they were removed from units last year. Horribly inaccurate. Personal choice, ADC makes a BP cuff system that is one handed guage and trigger. Comes in a kit with infant, child, adult, large adult and thigh cuff all in one. Very nice and haven't had any problems.

[Ebon]

The lifepack 12's we carry have an automated BP cuff.

It is very convenient and relatively accurate, definately a good idea to take a manual baseline pressure though initially.

Also generally take em maunually when dealing with hypo/hyper tensive pts.

So anyways I would say it is good 80% of the time, so it gets my 2 thumbs up.

ALso the lifepack 12's code summary makes writing PCRs a dream.

[schmidt]

Same thing with what others are saying, go manual. Automated ones are horribly inaccurate. When giving report nurses always question vitals (bp) given because as soon as we leave they take there "nurse on a stick" (o2, bp, temp......) and find theres set off from ours.

[FLASHOVER05]

because as soon as we leave they take there "nurse on a stick" (o2, bp, temp......) and find theres set off from ours.
Then who is right and who is wrong??? nothing is 100% fool proof nor is any piece of equipment come with a Lifetime gaurantee of perfection.

[CrazyLadder]

Thanks gang, I've been playing with a wrist model. Easy to use, don't need to access the elbow area, gives Bp and pulse rate and very small. It varies in readings. If you have a large wrist it is inaccurate, it works best when you are sitting comfortably in a chair with a beer in hand. I plane to test a few other models. I totally agree that manual is the most accurate.

[firewhirly]

Have also found the automated bp's to be essentially usless, they give widely variable readings, and in a truck bouncing down the roads... ya might as well toss them out the truck. Heck even the old fashion way in a truck bouncing down the road it is a challenge sometimes. Manual is definately the way to go. One thing to note, if your pt has a radial pulse (the one in the wrist) they have a BP of at least 80 systolic. Even knowing that much will tell the paramedics something about the pt's condition. Other info that is good to pass along if you are checking the pulse is if it's regular, irregular, weak strong etc.. same goes for the resp rate.

[PEMS17]

Have also found the automated bp's to be essentially usless, they give widely variable readings, and in a truck bouncing down the roads... ya might as well toss them out the truck. Heck even the old fashion way in a truck bouncing down the road it is a challenge sometimes. Manual is definately the way to go. One thing to note, if your pt has a radial pulse (the one in the wrist) they have a BP of at least 80 systolic. Even knowing that much will tell the paramedics something about the pt's condition. Other info that is good to pass along if you are checking the pulse is if it's regular, irregular, weak strong etc.. same goes for the resp rate.
Just further to the 80 systolic at the radial, 70 systolic for a femoral, and 60 systolic for a carotid. Roughly 98% of the time 19 times out of 20.
Personally if you want a BP cuff to check your own BP the wrist machine may do it. For patient care though go with the arm system (exchangable cuff system HINT HINT) The wrist machines rely on the same technology to sense the BP as far as I know. Use the Brachial with a set of stets and you will be better off, and yes you can assess your pulse to a certain degree while listening.

[irsqyu]

We too have been using the automated cuffs for a couple of years, they are really not to accurate( prolly because we bought them at the local drug store). We are going back to the manual BP, but even though we do a lot of medical calls, with position rotations on the truck, we really don't get to use it as much as we should to be as proficient as the medics. We use a Zoll SAED with SPO2, 3 lead ECG strips and it also gives us the pulse. Personally it doesn't matter what the SPO2 reading is, we usually go by the look of the patient, and how they are feeling.

[dentedhead]

We too have been using the automated cuffs for a couple of years, they are really not to accurate( prolly because we bought them at the local drug store). We are going back to the manual BP, but even though we do a lot of medical calls, with position rotations on the truck, we really don't get to use it as much as we should to be as proficient as the medics. We use a Zoll SAED with SPO2, 3 lead ECG strips and it also gives us the pulse. Personally it doesn't matter what the SPO2 reading is, we usually go by the look of the patient, and how they are feeling.

Youve had some coaching on that havent youLOL!

Dentedhead

[irsqyu]

Youve had some coaching on that havent youLOL!

Dentedhead
Well I was told when we started to use automatic cuffs, that we would be back to manual before long, and it appears that "someone" was prolly right. He is now trying to convince me to buy an Apple computer, but that's not going to happen. As a firefighter I still believe the automatic cuff is the best( If we could find a reliable product) just for the fact we don't do the procedure often enough to become totally proficient. I don't even believe that the BP is really important to us as firefighters except to give the medics a benchmark to see if there is any change in the patient in the timeframe since we arrived, the medics are going to do their own set of vitals anyway. I have seen that they appreciate knowing the SPO2 reading prior to our administration of Oxygen. I will also say that any procedures like BP that we do while awaiting the medics keeps the family more relaxed as we are at least doing something, not just standing around.

[dentedhead]

Well I was told when we started to use automatic cuffs, that we would be back to manual before long, and it appears that "someone" was prolly right. He is now trying to convince me to buy an Apple computer, but that's not going to happen. As a firefighter I still believe the automatic cuff is the best( If we could find a reliable product) just for the fact we don't do the procedure often enough to become totally proficient. I don't even believe that the BP is really important to us as firefighters except to give the medics a benchmark to see if there is any change in the patient in the timeframe since we arrived, the medics are going to do their own set of vitals anyway. I have seen that they appreciate knowing the SPO2 reading prior to our administration of Oxygen. I will also say that any procedures like BP that we do while awaiting the medics keeps the family more relaxed as we are at least doing something, not just standing around.

I agree with the 02 sats,thats a pretty important starting point for an assessment/report if pertinent.I wish we had that feature,the machine does but our dept chose not to go with it.Nor can I "run a strip" straight defib only.

Dentedhead

[Squamish-FF]

One big pulse ox trap that is very relevant to us as firefighters is, people who have smoke/carbon monoxide inhalation will have usually have a false high SpO2 reading due to the hemoglobin being saturated with compounds other than oxygen. As in carbon monoxide.

Other circumstances that can produce false readings:

*Excessive ambient light on the probe
*Patient movement
*Hypotension
*Hypothermia/Vasoconstiction
*Patient use of vasoconstrictive drugs
*Dark colored nail polish
*Jaundice

Remember no one has died from too much O2 but many have died with not enough!

When in doubt give oxygen.

As mentioned earlier, it is nice to have a pre-oxygen admin reading, as the Doc will usually ask. Do not withhold O2 to get this reading,though you can have a pulse oximeter on a digit before your partner can have the oxygen set up.

[NBmedicFF]

Not sure if someone posted this or not, but false readings may be coming from an improperly sized cuff rather than the machine. Common mistake for people to use the same cuff on everyone. If the cuff doesn't fit according to the markings on it you will get the wrong reading.

too small = false high
too big = false low

[irsqyu]

Remember no one has died from too much O2 but many have died with not enough!

When in doubt give oxygen.

As mentioned earlier, it is nice to have a pre-oxygen admin reading, as the Doc will usually ask. Do not withhold O2 to get this reading,though you can have a pulse oximeter on a digit before your partner can have the oxygen set up.[/QUOTE]


Totally agree with you on this one, long before SPO2 sensors, we usually administered O2 by the look of the patient, we pretty well do it that way now. If we pull up to the home at the same time as the medics, we usually have done the spo2, administered the O2 and run an ECG strip by the time they unload their stretcher and bags and get to the home and make patient contact!

[Dave404]

Totally agree with you on this one, long before SPO2 sensors, we usually administered O2 by the look of the patient, we pretty well do it that way now. If we pull up to the home at the same time as the medics, we usually have done the spo2, administered the O2 and run an ECG strip by the time they unload their stretcher and bags and get to the home and make patient contact![/QUOTE]

I have to agree - treat the patient...not the machine!