Podcast 779: Pulse Pressure in Trauma

Contributor: Aaron Lessen, MD Educational Pearls:

• Pulse pressure is the difference between the systolic and diastolic blood pressure, normal is about 40
• A narrow pulse pressure is generally thought of as less than 30 mmHg which may signal peripheral vasoconstriction in response to lower blood volumes
• 2020 study examined hypotension and narrow pulse pressure in trauma and outcomes
• 37% of patients who were hypotensive on ED arrival had a severe injury, 22% of patients who had a narrow pulse pressure had a severe injury, and 11% of patients with normal blood pressure and normal pulse pressure had a severe injury
• Need for thoracotomy, death, cardiac arrest, and need for other interventions was highest in the hypotensive group, the lowest in the normal blood pressure/normal pulse pressure group, and narrow pulse pressure group outcomes fell in the middle
• Narrow pulse pressure in the setting of trauma may be a helpful vital sign to incorporate into trauma care in the ED

References

Schellenberg M, Owattanapanich N, Getrajdman J, Matsushima K, Inaba K. Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma [published correction appears in J Surg Res. 2021 Oct 6;270:1]. J Surg Res. 2021;268:284-290. doi:10.1016/j.jss.2021.06.051

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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