THE AMBULANCE DRIVER’S PERSPECTIVE
Try these tips to take some of the pressure off of getting a blood pressure
Isolate the patient’s arm from everything else. When you wrap the cuff around his arm, cup your non-dominant hand under his elbow, and tuck his palm beneath your elbow. Lift his arm off the mattress, stretcher rail, or whatever it’s in contact with. If you like to lay the patient’s arm across your lap while you auscultate a BP, lift your feet onto tiptoes to minimize transmission of road noise through the soles of your feet.
Use the bell of your stethoscope, not the diaphragm. I spent 18 years in EMS without learning that trick, and it took a Stethoscopy For Dummies class from Bob Page for me to see the light. The bell of your stethoscope works better on those low-frequency sounds. Try for yourself, and you’ll see.
Use a good stethoscope. While you’re on that initial gear-buying spree right after graduation from EMT school, say no to the spring-loaded window punch, Swiss army knife trauma shears and the glove holster, and treat yourself to a nice stethoscope instead. A few hundred bucks spent in the beginning will pay a career’s worth of dividends. And whatever ‘scope you buy, take off the stock diaphragm and replace it with a disposable antimicrobial diaphragm. They’re cleaner, safer for your patient, and they’re much more acoustically sensitive.
Turn your cuff upside down. You know those hoses that bump annoyingly against the head of your stethoscope? You can get them out of the way by turning the cuff upside down. It won’t affect the accuracy of your findings, as long as you make sure the artery markers are still lined up correctly.
Learn to palpate. It’s not optimal, but sometimes you just can’t hear a pressure. In all my time in EMS, I’ve only met one person that can get an accurate systolic and diastolic pressure from palpation, but unless your name is Liz Hyde, you’ll just have to do like the rest of us mere mortals and settle for a rough systolic pressure.
Turn off all the crap in the back of the rig. Being spec’ed for use in Louisiana summers, our rigs are equipped with air conditioners that keep the module a comfy 72 degrees – or at least that’s the rumor. But however well they cool or don’t cool, hearing anything over them is like straining to hear the whispered words of a lover over an F5 tornado. Except in the case of blood pressures, you can’t lip read, smile and nod.
If you’re one of those EMTs whose ears threaten to betray you when you need them most, try some of these BP tricks. Hopefully, they’ll take some of the pressure off of getting a pressure.