Scenario

[Guest guest]

First, let me say that I appreciate Wes's taking the time to formulate and post

the scenario. It is an excellent learning tool. If some do not see it as such,

there is a key on the upper right part of the computer keyboard marked " delete "

that is quite easy to use.

Now, on to the scenario.

I've been thinking about this, and two things to ask come to mind: (1) If BPs

cannot be obtained in either arm, can a BP be obtained in one or both legs? (2)

does the physical examination reveal any scars from prior surgical procedures?

Also, in taking a history from this patient, what questions would you ask that

have not been asked yet?

I think Wes is working tonight and may not be able to respond immediately, but

do any of you find these questions pertinent? Why or why not?

If BPs were obtainable in the legs, what conclusions would one draw? What

surgeries might result in inability to obtain BPs in either arm? What

conditions could lead to this situation?

And just to be a cranky old man (which I am) , for those who are " only " Basic

EMTs, and I say that with the greatest admiration for what you do and in no way

intend to denigrate you, what questions would a Basic EMT have if a patient had

a heart rate of 72, radial pulse of 72, regular, and full, but no obtainable BPs

in the arms. What would you do? See if there were radial pulses? See if there

was a carotid pulse? See if there was a femoral pulse? Take a BP in the leg?

Ever tried that? It's hard but can be done. You need the " elephant cuff " to do

it, however unless you use one of the pedal pulses. Anybody ever tried that?

Further, does it seem odd that a patient with no auscultatable BPs in either arm

but with a responsive LOC might have a regular heart rate of 72? Wouldn't a

patient with such profound hypotension as to have no obtainable BPs in either

arm be compensating with catecholamine release resulting in an increase in both

systolic and, in particular, diastolic BP?

Just some questions that come to my mind as I Google to try and find the answer

to this.

Gene Gandy, JD, LP, NREMT-P

Bujia EMS Education

Tucson, AZ