I’ve figured a 2-am cheat for the MAP, which doesn’t work half-bad. Not the linesy-roadsy MAP, the other kind.
Blood pressure is one of the more important measurements we can take, we all know that and I won’t belabor the point. If we’ve been in the business long enough, we get a feel for a blood pressure that’s “not right”, in the overall picture of patient age, habitus, etc.
The real golden nugget of the BP is, of course, the mean arterial pressure or MAP. This is the number which some studies suggest must be maintained over 60 (other sources state 65), and failure to do so results in poor organ perfusion or even organ ischemia. We’re talking kidney failure, liver problems, the works.
So, what is the mean arterial pressure or MAP?
Wikipedia defines it as “… a term used in medicine to describe an average blood pressure in an individual. It is defined as the average arterial pressure during a single cardiac cycle.” Great. Okay.
The article proceeds to inform us that to find the MAP, all we need to do is multiply the cardiac output by the systemic vascular resistance, and add the central venous pressure. Wiki tells us that the CVP “is usually small enough to be neglected in this formula”.
So the MAP is (CO x SVR).
And cardiac output is…? Along with systemic vascular resistance, it is hard to measure in the field, that’s what it is mes amis.
Wiki goes on to state that there are several ways to estimate the map, using the systolic blood pressure (SBP) and diastolic blood pressure (DBP). This is more my speed – I got those numbers. There are a few ways to use them to figure out MAP, to whit:
MAP = DBP + (0.33 x (SBP – DBP))
(English translation: Subtract diastolic from systolic, multiply that number by 0.33, then add diastolic back in.)
MAP = 2/3 DBP + 1/3 SBP
(English: multiply diastolic by 0.66, multiply systolic by 0.33, add those products)
MAP = ((2 * DBP) + SBP ) / 3
(multiply diastolic by 2, add in systolic, divide this number by three)
Yeah, right. This is just uno poquito mas math than I like doing.
Now, I’ve noticed a lot of ambulance folk are equipped with PDAs and the like, which is wonderful if you don’t mind whipping it out to calculate all this – with blood or vomit or worse on your gloves. Better and easier to do it in your head, if you need it.
For comparison purposes we’re going to use the third MAP equivalency formula, 2 times the Diastolic, plus Systolic, then divide the whole shebang by three. That’s the formula I’ve most seen touted in books and such for us field grunts. Using that formula, we see that for a patient with a BP of 80/40, this equals ((2 x 40) + 80 / 3), or (80 + 80)/3, or a MAP of 53.33.
Again, this is too much work.
The DTs 2-am MAP formula is: Systolic / 10 + Diastolic. Easy-peasy. This yields, from a BP of 80/40: 80/10 = 8, plus 40 is 48.
Like any good 2am rule, this is fast, easy, and wrong. Notice we’re a full five mmHg off the “official” estimated MAP.
Notice also that you wouldn’t probably bother figuring this out in this example, anyway – 80/40 is Not a Good BP, and you already know that. But if you’re wondering about the mean arterial pressure for a patient with a better-sounding BP, the formula works very nicely:
… and so on. Again, not many systems ask “What is the patient’s mean arterial pressure?” If you want to ballpark it, though, Systolic/10 + Diastolic is probably an easier way to go.
So, there it is.
Filed under: Learning Curve, MedMath, Tips and Tricks | Tagged: EMS, MEDMATH, Paramedic | 1 Comment »