Measuring BP in CS

[agranulocytosis]

---

Members don't see this ad.

For those that took the CS, if BP measurements for both arms were indicated, did you actually measure the BPs in both arms or pretend to do it and make up a BP measurement?

On a similar note, did you check the vitals yourselves on each patient?

 

[Instatewaiter]

considering it's going to take you just about as much time to take it than to fake it, might as well take it.

 

[WhatUpDoc!]

I didn't take any vitals in the room, just took the door sign vitals as is because they said we could. Why waste time doing this when they blatantly tell you that you should use the vitals they give you when formulating your diff dx. and workup???

 

[beponychick]

I didn't take any vitals in the room, just took the door sign vitals as is because they said we could. Why waste time doing this when they blatantly tell you that you should use the vitals they give you when formulating your diff dx. and workup???

So you didnt have to do orthostatics?

Thanks so much!

 

[WhatUpDoc!]

So you didnt have to do orthostatics?

Thanks so much!

No, just order if indicated. Of course I won't find out I passed until 2 friggin months from now, but I'm feeling good about it 😀

 

[MSKalltheway]

Why waste time doing this when they blatantly tell you that you should use the vitals they give you when formulating your diff dx. and workup???

👍

 

[Law2Doc]

So you didnt have to do orthostatics?

Thanks so much!

Don't thank him/her yet. I certainly wouldn't say you'll never have to do them if the scenario absolutely calls for it. They NEVER give you orthostatics on the door vitals, and it's not one of the studies they explicitly say you should request instead of do yourself. If a patient is there because they get dizzy every time they stand up, then in real life THE money in the physical exam is doing orthostatics. Nothing else tells you squat. But since it takes a lot of time to take a BP, change positions, wait 2 mins and take another BP, you only want to do orthostatics if you absolutely, positively would want to know. So yes, I'd say there are possible instances where you will want to do orthostatics (there certainly was a case in FA that called for it). But most of the time you won't need to take vitals otherwise. I'd say go into the test knowing that only in that one case (the patient who gets dizzy/faints with positional changes) will you do orthostatics, and you will be set. But if you do get that case, I think you are kidding yourself if you think you can just "order orthostatics" and get full credit on the physical exam.

 

[beponychick]

Don't thank him/her yet. I certainly wouldn't say you'll never have to do them if the scenario absolutely calls for it. They NEVER give you orthostatics on the door vitals, and it's not one of the studies they explicitly say you should request instead of do yourself. If a patient is there because they get dizzy every time they stand up, then in real life THE money in the physical exam is doing orthostatics. Nothing else tells you squat. But since it takes a lot of time to take a BP, change positions, wait 2 mins and take another BP, you only want to do orthostatics if you absolutely, positively would want to know. So yes, I'd say there are possible instances where you will want to do orthostatics (there certainly was a case in FA that called for it). But most of the time you won't need to take vitals otherwise. I'd say go into the test knowing that only in that one case (the patient who gets dizzy/faints with positional changes) will you do orthostatics, and you will be set. But if you do get that case, I think you are kidding yourself if you think you can just "order orthostatics" and get full credit on the physical exam.

Hey Law2Doc,

Thanks for your input. Always appreciate it. 🙂

If the case does call for orthostatics to be measured (for instance the case that you mentioned above), should I just make up the BP? I assume that the SP will actually not have orthostatic changes. Do they just want you to go through the motion?

Thanks again!

 

[Law2Doc]

Hey Law2Doc,

Thanks for your input. Always appreciate it. 🙂

If the case does call for orthostatics to be measured (for instance the case that you mentioned above), should I just make up the BP? I assume that the SP will actually not have orthostatic changes. Do they just want you to go through the motion?

Thanks again!

No -- you aren't the actor, your job is not to make things up. You do the physical exam. I think instatewaiter's point is a good one -- it will take you just as long to do things for real as to fake them, so do it for real. Assuming the BPs are equivalent, just say something like -- well your BP seems to be the same now.

 

[plainolerichie]

The video you take before the exam states "whatever BP they measure on the door, you should accept as accurate" and it seems like they don't want you to do it.

 

[Law2Doc]

The video you take before the exam states "whatever BP they measure on the door, you should accept as accurate" and it seems like they don't want you to do it.

But they don't ever give orthostatics. So you will never have positional BPs, just seated. You are reaching if you are trying to conclude that they would have given you orthostatics if they wanted you to know them. If you read FA, there is an example in there where orthostatics is deemed a critical part of the PE, and FA seems to be pretty on the mark in terms of what the SPs do, say and are giving points for. And they give you a BP cuff in every room. So I think you are kidding yourself if you think checking a BP is never warranted. If you don't care about orthostatics then sure, you can go with what's on the door. But if it's a case where someone faints every time they stand up, then the key part of the physical exam is going to be to check the positional BP. You can't in real life just say, well the nurse wrote 110/80 so the BP is fine in all positions, and since you can't do it in real life, you can't do it on this test. Again, it's just that one scenario (positional changes resulting in fainting, dizziness, etc), because it's time consuming to take BPs, and they don't give you much time.

 

[drmansi]

I just got my cs result . pass

i never took any vitals .. had one dizziness case considered taking it but never had the time so mentioned it in my note .. and from al the experiences
I have heard I dont think you will lose any major points if u skip it ..