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.
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! 👍🌟🌟🌟🌟🌟
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!
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!
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.
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?
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.
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?
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!
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.
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?
the true hero we didn’t know we needed
You’re too sweet, Amanda. ☺️
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.
😬😬😬 yep. That’s a good point.
Ahh thank you for this and the article links in your videos 👍🏽. We were just discussing this topic regarding a pt with an impella.
My pleasure! Taking the BP in a pt with an Impella is a whole different beast. Hope you had an arterial line!
@@eddyjoemd regarding patients w/arterial lines, does this concept apply as well?
I'm an RN in a CVICU. This concept was really helpful. I really enjoy your videos! Thanks!!
Glad to be able to help!
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!
👍🌟🌟🌟🌟🌟
Spreading this video and other such knowledge is paramount to doing so!
Thanks for the videos! Dropping a comment to help with the algorithm
Appreciate it a million, Faisal! 💪🏼
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!
My pleasure, Johnny Bananas!
Great video! Thank you for sharing your knowledge ❤️🙏
My pleasure!
Ty!
You’re welcome!
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!
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.
thank you. its really going to change my practice
My pleasure! Glad it helped you and your patients!
Thanks for your clear explanation.
My pleasure!
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?
hii Dr Eddy
Could u pls make a video on role of a Respiratory Therapist In ICU
please ....
#Love ua channel #Love ua content
Different hospitals use RTs differently. It would be challenging to make a video regarding the many many roles of RTs.
@@eddyjoemdI am a 3rd year RT student sir , I am eagerly waiting for it sir ...
Great educational video
Thanks, Amanda!
Awesome content!
Thanks!
thank you for this video, i have a question about medications that drop blood pressure, if you cannot give meds if SBP
was there an answer to this question. -- thinking of Metoprolol and advice re danger of going below 100 SB*P
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.
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?
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!
Hello sir,
Just to clear we should rely on MAP calculated by machine rather than manually???
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.
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?
It's Korotkoff. Not kortokoff.
Yeah my bad. My Russian isn’t very good.
😎
💪🏼💪🏼💪🏼
Good stuff.
Thanks Nate!
What a loser this guy is commenting on videos