Systolic pressure at the moment of lysis is the single most modifiable input to bleeding risk, and it is very often a number that was recorded somewhere else, some minutes ago, by an automated cuff on a patient who has since been moved, undressed and cannulated.
Pain, anxiety and a full bladder all raise it. So does an oversized reading from a cuff that is too small for the arm - a common error in larger patients, and one that pushes a borderline reading over a threshold. An unrecognised interarm difference does the same in the other direction.
Before a fibrinolytic goes in, take the pressure again yourself, with a correctly sized cuff, in both arms if there is time, after the analgesia has worked. Treating pain and repeating the measurement is a legitimate way to bring a borderline pressure down before lysis; it is not a way to argue away a genuinely high one.
- Repeat the pressure yourself immediately before lysis rather than using the triage reading.
- Match the cuff to the arm - an undersized cuff reads high and can cross a threshold spuriously.
- Treat pain first; analgesia often brings a borderline systolic down on its own.
- Check both arms where time allows, and act on the higher reading.
- Document the pre-lysis pressure and the time it was taken.
Why it matters
The number in the notes is often a triage reading taken before analgesia, and the decision rests on it.
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