Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study

• Published in: BMJ Vol. 321; no. 7262; pp. 673 - 674
• Main Authors: Deakin, Charles D, Low, J Lorraine
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 16.09.2000; British Medical Association; BMJ Publishing Group LTD; British Medical Journal
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Carotid Arteries - physiopathology; Carotid artery injuries; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Estimate reliability; Femoral Artery - physiopathology; Guidelines as Topic; Humans; Intensive care medicine; Medical sciences; Middle Aged; Palpation; Patients; Pressure pulses; Pulse; Radial Artery - physiopathology; Reference Values; Sensitivity and Specificity; Shock - physiopathology; Systole; Systolic blood pressure; Human; Systolic pressure; Femoral artery; Intensive care; Hypovolemia; Cardiovascular disease; Arterial pulse; Handbook; Trauma; Carotid; Arterial pressure; Hemodynamics; Predictive factor; Radial artery; Monitoring
• DOI: 10.1136/bmj.321.7262.673
• ISSN: 0959-8138; 0959-8146

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; if carotid and femoral pulses are palpable, the systolic blood pressure is 70-80 mm Hg; and if the radial pulse is also palpable, the systolic blood pressure is more than 80 mm Hg. 1 The only study to examine the accuracy of this model used non-invasive blood pressure measurements, which have a tendency to underestimate systemic arterial blood pressure during hypotension. 2 No reliable data are therefore available to support the advanced trauma life support guidelines on which clinical decisions are made. Methods and results After obtaining approval of the study by the ethics committee, we studied sequential patients with hypotension secondary to hypovolaemic shock and in whom invasive arterial blood pressure monitoring had been established.