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I was under the impression that anyone on a stimulant should have annual EKG...but today I was told that it is only for patients who have cardiac risk factors...true?
 

PistolPete

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I don't. Per AACAP guidelines, I'd only refer for cardiac clearance if there is a history of sudden death in the family or early MI (MI before age 50). The pediatrician or pediatric cardiologist can do the EKG, interpret it, and then write a note saying something to the effect of "cleared for stimulants."
 
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I do a blood pressure if one hasn't been documented in the chart recently. One of these days I'll get a stethoscope to replace the one I lost halfway thru intern year to just do it manually since my auto-cuff gives crappy readings on anyone with a large arm.
 
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Shikima

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I do a blood pressure if one hasn't been documented in the chart recently. One of these days I'll get a stethoscope to replace the one I lost halfway thru intern year to just do it manually since my auto-cuff gives crappy readings on anyone with a large arm.
Get a wrist cuff. Easier.
 

birchswing

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Get a wrist cuff. Easier.
It's not easier because you have to be even more attentive to positioning than with a brachial monitor. But I guess it could save having to buy a larger brachial cuff. They're so inexpensive that I don't see the issue with having multiple cuffs.

But a single spot reading with a wrist monitor with a high degree of variability in positioning seems nearly useless to me. There is already blood pressure variation during a day to begin with that I'm not sure any singular reading is useful by itself, but the wrist especially so.

I've found that some nurses do not take blood pressure properly (don't support the arm, take it immediately after patient sits down) and also will sometimes jab a thermometer in your mouth at the same time as starting BP measurement and a pulse ox on the hand of the arm the BP is taken on (the perfusion index of the hand of the arm where BP is being taken will drastically reduce making the pulse ox reading less reliable). This makes all the readings haywire, as the thermometer is nearly falling out of the mouth and the patient may have to adjust to keep it from falling out.

I've found that for myself using an Omron 10 786n brachial monitor, I can get consistent results per situation because I can control for factors such as proper positioning, arm support, sitting upright for several minutes quietly without a lot of other prodding etc. I'm also able to experiment to see how different factors affect BP readings. I may be a bit obsessive in how many readings I've taken, but having taken a large number of readings in various settings (lying, sitting, standing; immediately after change in posture vs. waiting; arm level) has made me not take a great deal of stock in a single reading taken at a doctor's office when a lot of weird variables are at play. There is consistency in how those variables affect BP, but knowing my range is more important to me when deciding on treatment than a single reading.

Some articles about recent research on BP range and its relevance to stroke:

High blood pressure: New research suggests see-sawing readings are the key danger sign for strokes... | Daily Mail Online

Blood pressure changes before stroke
 
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Crayola227

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It's not easier because you have to be even more attentive to positioning than with a brachial monitor. But I guess it could save having to buy a larger brachial cuff. They're so inexpensive that I don't see the issue with having multiple cuffs.

But a single spot reading with a wrist monitor with a high degree of variability in positioning seems nearly useless to me. There is already blood pressure variation during a day to begin with that I'm not sure any singular reading is useful by itself, but the wrist especially so.

I've found that some nurses do not take blood pressure properly (don't support the arm, take it immediately after patient sits down) and also will sometimes jab a thermometer in your mouth at the same time as starting BP measurement and a pulse ox on the hand of the arm the BP is taken on (the perfusion index of the hand of the arm where BP is being taken will drastically reduce making the pulse ox reading less reliable). This makes all the readings haywire, as the thermometer is nearly falling out of the mouth and the patient may have to adjust to keep it from falling out.

I've found that for myself using an Omron 10 786n brachial monitor, I can get consistent results per situation because I can control for factors such as proper positioning, arm support, sitting upright for several minutes quietly without a lot of other prodding etc. I'm also able to experiment to see how different factors affect BP readings. I may be a bit obsessive in how many readings I've taken, but having taken a large number of readings in various settings (lying, sitting, standing; immediately after change in posture vs. waiting; arm level) has made me not take a great deal of stock in a single reading taken at a doctor's office when a lot of weird variables are at play. There is consistency in how those variables affect BP, but knowing my range is more important to me when deciding on treatment than a single reading.

Some articles about recent research on BP range and its relevance to stroke:

High blood pressure: New research suggests see-sawing readings are the key danger sign for strokes... | Daily Mail Online

Blood pressure changes before stroke

yes all the points you make are important in making an actual diagnosis of hypertension, it definitely isn't done on a spot reading

I don't know the evidence but I think the key thing is that there is value in screenings letting a provider know that they need to investigate further

when I rushed to my dentist the other day and they had me hold my arm up for the wrist monitor and my reading was <110 mmHg, I think we all felt pretty good that I wasn't going to stroke out in the chair

OTOH, had it been high, we all would have known that this issue warranted further investigation, likely under better circumstances, with better equipment, and on more than one occasion
 
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