Actually overheard on scene

“His blood pressure is eighty-over-palp, but I couldn’t find a radial pulse.”

Never mind the fact that the patient had a very palpable radial pulse, and a blood pressure that was auscultated at 140/70.

I suppose at one point in time, the blood pressure could have been 80/P, and the patient could have had a radial pulse that wasn’t palpable…

But that wasn’t the case, now was it?

Comments

  1. I palp BP from the brachial all the time…

    • Where exactly do you put the cuff when you do this?

      • Upper arm per usual. Palpate at the AC.

        • Ah. Interesting. I typically palpate the brachial about midway up the humerus. I never thought of palpating at the AC.

          • That’s where I was taught to look for it, and what I usually see in textbooks… but I find it super tough to feel even at the best of times. The AC is near the surface, flat and localized (don’t have to go dissecting through biceps), and I’m usually there anyway since I palpate to see where to place my scope. It’s good stuff — I go there whenever I can’t find a radial pulse, and after that it’s usually straight to an apical (for obviously alive people, I mean).

            I try to teach my new folks that you can get a pulse anywhere you can readily locate an artery, and if you can compress it proximally, you can take a BP there (palpate it anyway, and auscultate if you can put your scope close enough to hear the turbulence). Not that they’ll be looking for popliteals or whatever all that often — although it’s nice to have the ability — but more to push the understanding of what they’re doing and that it’s part of physiology, not just a Magic Button. (For instance, I sometimes show them that you can even “palpate” a pressure using the waveform from a distal pulse ox probe.)

          • Good stuff, Brandon. Thanks.

        • Yep I do the AC thing as well to figure out where to place my scope. I usually go to back to wrist if I’m checking a palp, but I could see a reason to stay up there if you had trouble finding the radial. Not saying that’s what happened here, but it’s a plausible theory. Glad to see Brandon and I share a similar practice yet again…

  2. Pt pale, sweaty, and lethargic. Firefighter calmly tells me vitals: “His pulse is 25.”

    Me: “You mean his respirations, right?”

    FF: “No. His pulse.”

    Me: “Hand me that pacer.”

  3. Yep. Rolled up on one scene to find an EMT trying to auscultate a BP with his eyes closed. As I grabbed my cuff and tried to come up with a nice way to say, “Please get out the way, sir”, he mumbled something about not getting it and proceeded to reinflate the cuff, ditch the stethoscope, and palpate a carotid.

    I found great humor in his saying “I’m not getting it.”

  4. The absolute worst is “His BP was 90/p so we sat him up to see if he was postural and he passed out.”

    Fucking morons.

    Sorry for the profanity, it’s the single malt talking.

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