ATLS’ 80/70/60 rule
On the basis of location of pulse palpable, minimum systolic blood pressure can be predicted as follows:
- Radial/Dorsalis pedis/Popliteal pulse: >80 mmHg
- Femoral pulse: >70 mmHg
- Carotid pulse: >60 mmHg
Overestimation of SBP by Pulses
Pulse characteristics are an unreliable sign and “should be used only as a last resort.”
The 80/70/60 rule taught by the prehospital medicine and older editions of ATLS courses tend to overestimate the patient’s blood pressure. This has been shown by two different studies.1Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ. 2000 Sep 16;321(7262):673-4. doi: 10.1136/bmj.321.7262.673. PMID: 10987771; PMCID: PMC27481. 2Poulton TJ. ATLS paradigm fails. Ann Emerg Med. 1988 Jan;17(1):107. PubMed PMID: 3337405.
Although the radial pulse always disappears before the femoral, which always disappears before the carotid, most patient’s BP is lower than that predicted by these guidelines.
Note: These rules have been ommited in the newer editions of ATLS course.
Reference: Wilderness Medicine E-Book: Expert Consult Premium Edition – By Paul S. Auerbach