Endangered Species

A Regular Sphygmomanometer (Blood Pressure Cuff)

Have you notice how manual blood pressure cuffs are becoming extinct on hospital wards? I'm adding them to my "endangered species" list. It seems fewer and fewer people use these on the inpatient wards anymore. Instead, hospitals seem to be gravitating toward wall-mounted or cart-mounted electronic versions that can take your temperature and pulse oximetry, too, like the one to the right.
These electronic versions do not require the use of - dare I say it - a stethoscope and ears. (I've already commented on the quality of stethoscopes has suffered with the advent of the little plastic stethoscopes, so with these new-fangled gizmos, we don't even need those!).

One reason hospital administrators have migrated away from these manual BP cuffs is because they have lots of complicated detachable parts - the rubber bulb cracks and loses air, the tubing similarly fractures, and the calibration of the BP meter itself was difficult to maintain from the heavy use these devices see. But the new devices have even more issues, it's just that now we have to call a specialist to fix them. But, hey, at least they look cool.

The mobility of these old-fashioned, untethered devices had several advantages over their technogeek counterparts: (1) they permitted measurement of blood pressures in different patient positions - supine, sitting, and standing (recall that we call these orthostatic blood pressures) - since they are less resistant to motion artifact and (2) the manual version can recognize a drop in blood pressure faster than you can say "Holy Sh**!" Many a poor patient has hit the deck while the techoversion keeps inflating the cuff higher and higher in its attempts to find a hypotensive patient's blood pressure.

Recently, I have been struck by the number of patients I have seen with loss of consciousness (syncope). Most are men over 70, and most of them on a ton of medications - and all episodes of syncope seem to generate a consultation for the cardiac electrophysiologist (my kids appreciate this - really they do).

But one of the more common drugs I see elderly men on are medications for prostatic hypertrophy - in particular, terazosin hydrochloride (Hytrin®) or tamsulosin hydrochloride (Flomax®). These medications are prescribed for benign prostatic hypertrophy (BPH) to improve urine flow, especially at night.

But they also can drop blood pressure.

And nothing will make you hit the deck faster that a full bladder, warm body (after being in bed), rapidly standing, and being on too much Hytrin - blammo - down like a ton of bricks. Quick, call the electrophysiologist for a pacemaker!

For some reason (and I suspect its the abandonment of the manual BP cuff), few people check orthostatic blood pressures anymore, and so a simple diagnosis (and treatment) is missed.

But then again, I guess I shouldn't complain.

-Wes