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

in the regions we have studied the direct effect of the moderate warming predicted in the next 50 years would be to reduce, at least briefly, both winter mortality and total mortality. This could be continued into a large, sustained reduction in overall mortality if additional action is taken to prevent relaxation of protective measures against outdoor and indoor cold stress as winters become milder. These findings should not, of course, diminish concerns about possible indirect effects of prolonged global warming, such as flooding of low lying areas due to a rise in sea level or about direct effects of heat stress in hotter regions. Contributors: WRK and GCD designed the study; WRK is guarantor and drafted the paper, and GCD computed the data. All authors assembled data and contributed to their interpretation and to drafting and revision of the paper.ritzky G, et al. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. R. Increased platelet and red cell counts, blood viscosity and plasma cholesterol level during heat stress, and mortality from coronary and cerebral thromboses. An evaluation of climate/mortality relationships in large US cities and the possible impacts of a climate change. Early increases in ischaemic heart disease mortality dissociated from, and later changes associated with, respiratory mortality after cold weather in south east England. 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. We assessed whether the guidelines accurately predict systolic blood pressure by palpation of radial, femoral, and carotid pulses in hypovolaemic patients in whom blood pressure was measured using invasive arterial monitoring. 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. An observer …