Blood Pressure Measurements in the ICU: Trust ONLY the MAP in Oscillometric Devices!

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Full disclosure. I did not learn this until I was a fellow in Critical Care Medicine. It is not widely taught. Do not feel bad that you did not know this. All I ask is for your help to share this with others so we all speak the same language and do the best for our patients.
What are the normal sounds you hear with the "old fashioned"/auscultatory method of taking a patients blood pressure?
Those sounds define the systolic blood pressure and diastolic blood pressure respectively.
Then you do math and could calculate the mean arterial pressure (MAP) by using the formula of (2xDBP)+SBP/3 but there are a number of different ways to derive the MAP.
Does the BP cuff you have in the ICU, hospital or throughout the majority of doctor offices have ears? Well if that's the case, you CANNOT assume that the SBP and DBP provided by these devices are exact.
Link to article: eddyjoemd.com/...
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Books I recommend for ICU Beginners.
Marino's The ICU Book: amzn.to/2M2oFVm
The Washington Manual of Critical Care: amzn.to/2MfmDR4
The Ventilator Book: Second Edition: amzn.to/2BYbyhK
The Advanced Ventilator Book: amzn.to/2nhvyTY
Essentials of Mechanical Ventilation: amzn.to/2vqQAnF
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Опубликовано:

14 окт 2024

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Комментарии : 49

@EwitzAmanda 5 лет назад

the true hero we didn’t know we needed

@eddyjoemd 5 лет назад

You’re too sweet, Amanda. ☺️

@mrkman901 5 лет назад

Wow. Thank you for bringing this forward! This is article is over 10 years old... truly had NO idea. To think that machines all use their own proprietary, patented algorithms... Remembering one case when I was a nurse in the ER.. someone had less than 30min of their “tpa window” and the machine kept displaying SBPs >185 as we kept giving more and more IV antihypertensives, chasing the number so the neurologist would green light the tpa. Looking back... we could have easily gotten a Doppler pressure to get an accurate systolic number.

@eddyjoemd 5 лет назад

😬😬😬 yep. That’s a good point.

@Pancakes0o 5 лет назад

Ahh thank you for this and the article links in your videos 👍🏽. We were just discussing this topic regarding a pt with an impella.

@eddyjoemd 5 лет назад

My pleasure! Taking the BP in a pt with an Impella is a whole different beast. Hope you had an arterial line!

@steveabraham3052 3 года назад

@@eddyjoemd regarding patients w/arterial lines, does this concept apply as well?

@syncro16se 4 года назад

This is very important, I wish you continue and revisit this subject, as I suspect it might take a lifetime to get the medical syste m to realize the fallacies and to actually do something about this! 👍🌟🌟🌟🌟🌟

@eddyjoemd 4 года назад

Spreading this video and other such knowledge is paramount to doing so!

@saraedoran 5 лет назад

I'm an RN in a CVICU. This concept was really helpful. I really enjoy your videos! Thanks!!

@eddyjoemd 5 лет назад

Glad to be able to help!

@bobbanana13 5 лет назад

Thanks for the videos! Dropping a comment to help with the algorithm

@eddyjoemd 5 лет назад

Appreciate it a million, Faisal! 💪🏼

@jakegav3226 3 года назад

Great video! Thank you for sharing your knowledge ❤️🙏

@eddyjoemd 3 года назад

My pleasure!

@johnlpa-c947 5 лет назад

Eddy, another awesome video! I loved this teaching. When I was working in the CVICU we essentially always had A-lines in our patients who were on pressors/inotropes but would correlate with the cuff. I always wondered how the cuff calculated it’s MAPs because based on the calculation it never made sense. Such a cool explanation. Thank you!

@eddyjoemd 5 лет назад

My pleasure, Johnny Bananas!

@brendanpike63 2 года назад

Hey Dr. Eddy, ICU nurse here, great video. On my unit we only use MAP when treating hypotension. However, what are the implications for hypertension here? Correct me if I am wrong, but MAP is not a good number to treat hypertension off of. So what does this mean for our patients when I'm giving labetolol or hydralazine, or titrating caffeine to keep an SBP less than let's say 160? Especially for floor nurses who never have arterial lines?

@sclair10 5 лет назад

Around 10:37 I finally understand why you were harping on this topic. As an ICU nurse I know how to manually calculate the MAP but always use the machine generated MAP. However, our neurosurgeons most definitely do give us systolic goals, and I roughly knew this number is machine generated and inaccurate because I've read the ICU book by Dr. Marino as well, but wish me luck reminding them of this fact :(. Thanks for the great info. One of my intensivist told me a bit about why we choose one pressor over another. I get that norepi is a precursor of dopamine and eventually epi. I assume that there are other endogenous hormones that neo and vaso replace but do not know which. If you ever need a topic, speaking in depth about pressers, use cases, when to max one versus the other, would be a cool video. I know one of our former intensivist did not want levo maxed without other pressers maxed first, she seemed to think levo was the last final kick before efforts become more futile. Sorry for the super long comment, thanks again!

@eddyjoemd 5 лет назад

Thanks for contributing to the channel! I am actually writing a lecture on where we stand with vasopressors that should be complete by the end of the year. You should definitely follow along on instagram as I will be covering the articles I review for the lectures. I will make videos on the matter as well.

@SKARTHIKSELVAN 5 лет назад

Thanks for your clear explanation.

@eddyjoemd 5 лет назад

My pleasure!

@andreii.6094 2 года назад

Thank you very much for your very well presented, clear, concise educational video. Your sharing it is much appreciated! I am curious, what is your opinion on measuring systolic and diastolic BP using a traditional method with a stethoscope - would you consider it more accurate than the values generated by automatic measurement devices through their algorithms? Is there a way to know accurate values of systolic and diastolic BP at all, or is only MAP accurate and nothing else?

@abhinavjainabhinav 5 лет назад

thank you. its really going to change my practice

@eddyjoemd 5 лет назад

My pleasure! Glad it helped you and your patients!

@mudasirahmed4804 5 лет назад

hii Dr Eddy Could u pls make a video on role of a Respiratory Therapist In ICU please .... #Love ua channel #Love ua content

@eddyjoemd 5 лет назад

Different hospitals use RTs differently. It would be challenging to make a video regarding the many many roles of RTs.

@mudasirahmed4804 5 лет назад

@@eddyjoemdI am a 3rd year RT student sir , I am eagerly waiting for it sir ...

@johnb1766 5 лет назад

Hey Eddy, thanks for the awesome videos. I'm a med student interested in CC currently on an ICU rotation. Quick question, does this mean that you can't use the monitor to evaluate pulse pressure? Do you take manual measurements to evaluate pulse pressure?

@eddyjoemd 5 лет назад

Hey John. You could use it to identify whether there's a wide pulse pressure or not. It's close but not exact. A manual cuff would be the better option here or an arterial line. If you're just doing some rough calculations the numbers on the monitor should be fine. Good luck!

@jessicachard9532 4 года назад

This is great information know! Never had it explained to me this way. Just to clarify, does that mean when we calculate a MAP ourselves after doing a manual BP that it is accurate? I mean, I don't often do manual BPs but just curious.

@cane523 3 года назад

Ty!

@eddyjoemd 3 года назад

You’re welcome!

@chemaha1 3 года назад

thank you for this video, i have a question about medications that drop blood pressure, if you cannot give meds if SBP

@Anneggrental 6 дней назад

was there an answer to this question. -- thinking of Metoprolol and advice re danger of going below 100 SB*P

@Amada__ 5 лет назад

Great educational video

@eddyjoemd 5 лет назад

Thanks, Amanda!

@smriti3245 4 года назад

Hello sir, Just to clear we should rely on MAP calculated by machine rather than manually???

@eddyjoemd 4 года назад

If you have an oscillometric device to obtain the blood pressure, you should rely on the MAP. You should not use the algorithm generated SBP and DBP to calculate the MAP.

@simssocialite 5 лет назад

Awesome content!

@eddyjoemd 5 лет назад

Thanks!

@molito68 5 лет назад

What I don't get is, when the cuff pressure is greater than systolic pressure then the artery is collapsed and so it would seem to me that no oscillations could be measured. Therefore the cuff pressure at which oscillations appear could be measured as the systolic pressure. Similarly, when the pressure in the cuff is lower than the lowest pressure in the artery, diastolic pressure, then no oscillations could be measured. Could you explain what I am misunderstanding here?