Blood Pressure Confusion

[colts]

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What does it mean when the question says "60/palpable mmHg". What is the normal range for that measurement?

Is that the systolic pressure?

 

[elektroshok]

That means bad

 

[thehundredthone]

If only one number is present it's usually the systolic BP.

 

[tkim]

What does it mean when the question says "60/palpable mmHg". What is the normal range for that measurement?

Is that the systolic pressure?

It is the systolic pressure, and is the number you get on the sphygmomanotmeter when you palpate for the return of radial pulse instead of auscultating for the Korotkoff sounds with a stethoscope. It should be 120 though perhaps a little less since it's palpated not auscultated.

 

[thehundredthone]

It should be 120 though perhaps a little less since it's palpated not auscultated.

A 60mmHg difference is too large be attributed to palpation vs. auscultation. Unless I misunderstood what you're saying here. 60/palpable in this case likely means that the carotid pulse is palpable (which corresponds to a systolic BP ~60mmHg)

 

[CDI]

A 60mmHg difference is too large be attributed to palpation vs. auscultation. Unless I misunderstood what you're saying here. 60/palpable in this case likely means that the carotid pulse is palpable (which corresponds to a systolic BP ~60mmHg)

Carotid pulse? Wot.

 

[thehundredthone]

The advanced trauma life support course teaches that if only the patient's carotid pulse is palpable, the systolic blood pressure is 60-70 mm Hg ...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27481/

Not disputing the (in)validity of the guidelines. Just providing a reference. 60 mmHg difference in BP readings between palpatory and auscultatory methods is a little too far fetched for me.

 

[KTD]

60/palp means that the systolic blood pressure was measured by palpation rather than auscultation. You find the radial pulse, inflate the cuff well past the point where the pulse disappears and let air out until the pulse returns. This gives you systolic BP. You can't measure diastolic this way. EMS might use this method if they can't hear the korotkoff sounds bc systolic is too low. Don't worry about it too much, just know 60 is systolic and diastolic was not able to be obtained.

 

[KTD]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27481/

Not disputing the (in)validity of the guidelines. Just providing a reference. 60 mmHg difference in BP readings between palpatory and auscultatory methods is a little too far fetched for me.

He was not saying the reading is 60 because it is being palpated. He was just saying the normal systolic is a little lower than 120 because of the method. In this example, the patient is clearly hypotensive. It is true that that you can estimate the blood pressure by palpating specific pulses (femoral means systolic at least 60, radial is at least 90 if I recall correctly), but this has nothing to do with recording the BP as 60/palp. This means the systolic is 60 measured by palpation method with the cuff rather than auscultation. Normal for this method is about 8-10 pts lower than by auscultation.

 

[tkim]

He was not saying the reading is 60 because it is being palpated. He was just saying the normal systolic is a little lower than 120 because of the method.

👍

 

[thehundredthone]

He was not saying the reading is 60 because it is being palpated. He was just saying the normal systolic is a little lower than 120 because of the method. In this example, the patient is clearly hypotensive. It is true that that you can estimate the blood pressure by palpating specific pulses (femoral means systolic at least 60, radial is at least 90 if I recall correctly), but this has nothing to do with recording the BP as 60/palp. This means the systolic is 60 measured by palpation method with the cuff rather than auscultation. Normal for this method is about 8-10 pts lower than by auscultation.

Understood, thank you for the clarification.

 

[Siggy]

A couple things...

1. I was under the impression that the carotid/brachial/radial pulse guestimation was dropped because, well, it was simply too inaccurate to be of any real use.

2. A XX/Palp pressure is done by pumping up the blood pressure cuff and then measuring when the radial pulse returns. When I went through EMT training, we were taught that it's generally about 10 mm/Hg lower than a properly auscultated BP. I can't provide any evidence to back that up, however even if that's true that would put your patient at a systolic of 70, which is too low anyways. While a palpated BP is less accurate than an auscultated one, the only way to go from 120/XX (or any other normal BP) to 60/P would be by gross user error.

3. Since it's impossible to palpate a diastolic BP, there is no diastolic number given with this method.

 

[thehundredthone]

A couple things...

1. I was under the impression that the carotid/brachial/radial pulse guestimation was dropped because, well, it was simply too inaccurate to be of any real use.

2. A XX/Palp pressure is done by pumping up the blood pressure cuff and then measuring when the radial pulse returns. When I went through EMT training, we were taught that it's generally about 10 mm/Hg lower than a properly auscultated BP. I can't provide any evidence to back that up, however even if that's true that would put your patient at a systolic of 70, which is too low anyways. While a palpated BP is less accurate than an auscultated one, the only way to go from 120/XX (or any other normal BP) to 60/P would be by gross user error.

3. Since it's impossible to palpate a diastolic BP, there is no diastolic number given with this method.

Right on all counts.

Regarding point number 2, the reason is that the Korotkoff sounds can be heard earlier with the stethoscope, before the return of flow strong enough to cause a palpable pulse. The 120 60 difference was a misunderstanding on my part.

I'm an international med student, so I'm not fully conversant with US medical terminology yet. To me, "palpable" did not intuitively imply that the palpatory method was used, but rather that the pulse was palpable.

 

[je355804]

What does it mean when the question says "60/palpable mmHg". What is the normal range for that measurement?

Is that the systolic pressure?

In trauma pts especially the BP is often so low that only a Systolic pulse is obtainable... i.e. 60 in this pt.