# Palpable BP's



## aflasa (Nov 20, 2019)

Do you guys associate different palpable pulse locations (inguinal, carotid, radial) with approximate systolic BP values? I've heard that's fallen out of fashion but I thought it was still being taught. If that's not used anymore, is there any equivalent way of approximating blood pressure in the field without a cuff?


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## Devildoc (Nov 20, 2019)

It's not that it's fallen out of fashion, it's that there is no science (i.e., research and literature) to underscore it as valid.  Everything is going, rightfully, to evidenced-based, scientifically-validated medicine.  It's slaying a LOT of old myths and legends.

The short answer is no, there is no way to validly presume a SBP given pulse points or without a cuff.


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## Johca (Nov 20, 2019)

It was taught back in the day that different location will sustain a pulse to feel by palpation a bit longer than other locations.  Essentially it was carotid and femoral arteries and if I recall correctly 90 systolic could be considered the BP if pulse was felt in these locations.  It wasn't an exact science and it was developed in a clinic setting and not at locations first responders would typically be trying to determine a blood pressure.

However, what was taught was to use sphygmomanometer and use palpation to determine BP. This is cut and past from the PJ medical protocols that was used back in the day:

"Because of aircraft noise and vibration, the measurement of blood pressure by auscultation with a stethoscope is virtually impossible. Therefore, systolic B.P. measurement must be accomplished by palpation of the brachial or radial artery." 

This method worked some what satisfactorily when in a warm (room temperature) or warmer environments, but not to well as fingers get effected by a cold environment.   One of the reasons I wasn't to happy with treating injured on the initial put in service H-60 helicopters is lack of heater to keep cabin warm.

This being said sphygmomanometer technology has improved in that listening for or palpating for a radial pulse is no longer required, but good circulation in at least one arm is still needed.


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## Devildoc (Nov 20, 2019)

Using the cuff and palpating a blood pressure for the systolic without using a stethoscope is still accepted practice.


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## aflasa (Nov 20, 2019)

Johca said:


> It was taught back in the day that different location will sustain a pulse to feel by palpation a bit longer than other locations.  Essentially it was carotid and femoral arteries and if I recall correctly 90 systolic could be considered the BP if pulse was felt in these locations.  It wasn't an exact science and it was developed in a clinic setting and not at locations first responders would typically be trying to determine a blood pressure.
> 
> However, what was taught was to use sphygmomanometer and use palpation to determine BP. This is cut and past from the PJ medical protocols that was used back in the day:
> 
> ...


That is downright fascinating. I think the values were carotid = 70, inguinal = 80, radial = 90, not that it matters anymore I guess. I wonder what other stuff I was taught that has no basis in EBM. As I make my transition to civilian medicine I expect to find out.


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## medicchick (Nov 20, 2019)

aflasa said:


> That is downright fascinating. I think the values were carotid = 70, inguinal = 80, radial = 90, not that it matters anymore I guess. I wonder what other stuff I was taught that has no basis in EBM. As I make my transition to civilian medicine I expect to find out.


60, 70, 80 was what I was taught in 2000/2001 civilian side.


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## Brill (Nov 20, 2019)

Devildoc said:


> Using the cuff and palpating a blood pressure for the systolic without using a stethoscope is still accepted practice.



I think I need to change Docs: he maintains that BP checks are now done rectally.


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## Johca (Nov 20, 2019)

Yep, those values cause a better recollection of being taught them other than I seem to recall there was a Femoral value too.  Could be was implying highest systolic, not the lowest if carotid or femoral was the only locations a pulse was palpable, particularly when the first responder and the injured are outside in cold temperatures (Includes wind chill) sufficient to numb the first responders fingers.  70-90 is a very narrow range when dealing with injuries causing significant blood loss.  80mm Hg systolic is generally considered to be highly indicative of shock at a level the body is having difficulty to cope with (ie renal failure and other organ failure complications highly probable).


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## Johca (Nov 20, 2019)

Well if BP is now done or can be done rectally, I guess my doc (female) either believes I would enjoy such use and abuse too much during a routine medical exam or I don't have a sufficiently attractive butt.


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## Brill (Nov 20, 2019)

Johca said:


> Well if BP is now done or can be done rectally, I guess my doc (female) either believes I would enjoy such use and abuse too much during a routine medical exam or I don't have a sufficiently attractive butt.



true story: my first prostrate check in the military was done by a gorgeous blonde flight surgeon (female) at the Naval Academy. Hernia check was fine but then “turn around“ was met with my “wait, what?”


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## Johca (Nov 20, 2019)

Well I too encountered a female flight surgeon doing my annual physical over the years.  I was 19 and their was a female flight surgeon know as R squared (fist & last name started with r) and she wore cowboy boot with her skirt uniform (popular with Navy officers back in 1974/75) getting my annual class III/diver physical.  Nothing inappropriate although I was hoping.

The only time I experienced any difficulty was biting my tongue during the exam as I was looking at an Air Force flight surgeon's (female) medical diploma from Oral Roberts University (shut down in 1989). Fortunately I kept my mouth silent as even 28 years ago putting such thoughts into words was a suicidal career move.


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## Devildoc (Nov 20, 2019)

Johca said:


> Yep, those values cause a better recollection of being taught them other than I seem to recall there was a Femoral value too.  Could be was implying highest systolic, not the lowest if carotid or femoral was the only locations a pulse was palpable, particularly when the first responder and the injured are outside in cold temperatures (Includes wind chill) sufficient to numb the first responders fingers.  70-90 is a very narrow range when dealing with injuries causing significant blood loss.  80mm Hg systolic is generally considered to be highly indicative of shock at a level the body is having difficulty to cope with (ie renal failure and other organ failure complications highly probable).



A lot of data endorses permissive hypotension, and even getting "just enough" to maintain CPP (cerebral perfusion pressure for y'all reading along).


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## Stretcher Jockey (Nov 20, 2019)

I've heard the associated BPs with their palpable locations, but instead of looking for an arbitrary number I've always had better success with mentation. Granted, all the MEDEVACs I've been on where I couldn't ascultate a BP, I did it by palp and titrated fluid for solid CPP/mental status like @Devildoc noted. It's kinda more gee-whiz information, imo.


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## policemedic (Nov 20, 2019)

It's nothing more than guesswork and voodoo.


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## x SF med (Nov 21, 2019)

policemedic said:


> It's nothing more than guesswork and voodoo.



You just described all tactical medicine in austere locations, could you be more specific, please?


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