
The Getting Back to the Basics article series is designed to provide the reader an opportunity to reset and refresh when it comes to specific topic areas associated with the care of patients in our field of practice. Last month, our article brought up the importance of a good assessment, and how to include the vital signs to go along with that assessment. This month, we are going to extend a little further into the realm of one of those vital signs and look at blood pressure, and the difference between taking a manual assessment of pressure and the use of non-invasive blood pressure devices.
Related: Taking a Manual Blood Pressure: Techniques & Pitfalls
Last month, I started with a story about how I first thought of the topic, but this month isn’t going to start with any great story. I am going to start with a personal opinion. I believe that when we are looking at and discussing blood pressure we are looking at one of the single most important vital signs when caring for a patient that is suffering from a medical or traumatic situation.
Blood pressure is a measurement that shows the force exerted against the walls of the arteries as the heart contracts and relaxes pumping blood throughout the body, thus facilitating systemic perfusion. If asked, the normotensive patient would exhibit a blood pressure of around 120/80. Those that have been in the field for any significant period would know that attaining a pressure specifically 120/80 is like capturing a unicorn, but it is possible. At a specific point above or below that number, the patient can be considered hyper or hypotensive, and those numbers can be significant depending on the condition of the patient.
Related: Should We Measure Endotracheal Tube Intracuff Pressure?
In the content that I included in last month’s article, I referenced a quick, non-scientific paragraph that I use in demonstrating trends in the patient. In looking at the patient’s overall condition, much of this graph focuses on using blood pressure as an indicator. Once I determine where we think the patient is on the graph, I insert the points for compensated shock, decompensated shock, and irreversible shock. The National Institute for Health defines the line between compensated and decompensated shock to be indicated by the systolic blood pressure of 90mmHg. Therefore, when we plot our patient’s condition on the graph and it falls above 90mmHg the patient is considered to remain in a compensated condition; however, a set of vital signs below the 90mmHg would indicate the patient is no longer compensating, can no longer manage with internal mechanisms, and needs an even higher level of care.
The proliferation of non-invasive blood pressure (NIBP) devices has increased significantly as most cardiac monitor producers have included the capability on their premier devices. As this proliferation has occurred, more providers have focused on the use of these devices versus the use of manual blood pressure.
The Importance of Taking Manual Blood Pressure and Why We Must Remain Sharp in This Area
Related: Blood Pressure Management Goals in Stroke Care
Manual blood pressure assessment is a perishable skill. The combination of using the sphygmomanometer and stethoscope to take manual pressure, coupled with the need to ensure the right size cuff, with the pressure gauge in the right area, and the ability to hold the bell in the right place in possible deteriorating conditions can make manual pressures difficult to obtain. This is why many people tend to go directly toward non-invasive blood pressure (NIBP) devices. The issue with going toward the NIBP devices is that those devices are just that…devices.
Devices, or tools such as these are fallible and require verification of their results. In some areas, manual pressure is required by state medical direction, but it is also a good idea to use it as a confirmation assessment. After you conduct a manual pressure, you can complete the NIBP process and then compare the results of your first non-invasive pressure. Should those numbers be close, you can consider the NIBP results valid and can use those in the assessment of the patient. If the numbers are off, reassess your manual results and determine if you are off, or if the device is off.
Related: Ditch the Machine to Improve Accuracy in Blood Pressure Measurement and Diagnostics
In addition, there are times when the NIBP device will not read properly. As EMS clinicians in the field, you are with patients in their greatest time of need. If the patient is facing a life-threatening medical emergency, or if the patient has been involved in a traumatic incident that leaves the outcome of life in the balance, access to accurate vital signs is key to providing the right treatment at the right time. With NIBP devices, if the patient is in shock, and cannot consciously control muscle movement, the device can pick up movement in the results, or may require the device to continue attempting to get a valid reading prolonging the time required to get a good result.
Conclusion: Blood Pressure Is a Good Indicator of the Overall Health and Wellness of Patients
Understanding when manual blood pressure is required, and when you can use a non-invasive blood pressure device will aid in ensuring that you get the accurate reading at the right time to make the treatment decisions for your patient. Additionally, understanding the meaning of the blood pressure in the overall scheme will allow you to determine where the body may be attempting to compensate increasing your overall chance to help. Keep those manual skills fresh and keep your device calibrated, it may be needed at a moment’s notice.
Reference
Koya, H. H., & Manju, P. (2022, July 25). Shock – statpearls – NCBI bookshelf – national center for biotechnology …National Institute for Health. Retrieved April 8, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK531492/