You’re running a trauma activation, and everything is going great! Primary survey – passed. Resuscitation – lines in, fluid going. You are well into the exam in the secondary survey.

Then it happens. The automated blood pressure cuff indicates a pressure reading of 72/44 mmHg. But the patient looks so good!

You recycle the cuff. A minute passes, and another low pressure is noted, 80/52. You move the cuff to the other arm. Xray comes in to take some pictures. You roll the patient. 76/50. Well, you say, they were lying on the cuff. Recycle it again.

A minute later, the pressure is 56/40, and the patient appears gray, is very confused, and is diaphoretic. It’s real! But how long has it been really? An easy five minutes have passed since the first bad reading.

Bottom line: Sometimes it’s just hard to believe that your patient is hypotensive. They look so good! But don’t be fooled. If you get a single hypotensive reading, STOP! You have 90 seconds to figure out if it’s real, so don’t do anything else but. Check the pulse rate and character with your fingers. Do a MANUAL blood pressure check. It’s fast and accurate. If you have the slightest doubt, ASSUME IT’S REAL.

This tip also applies when you get an error reading or the cuff does not detect a pressure. You can take a moment to check central and peripheral pulses, but you must still get a real reading on a blood pressure cuff within 90 seconds. If you can’t, the hypotension is the real deal and must be treated appropriately. And immediately.

Don’t get suckered into trying to figure out what’s wrong with the cuff despite how good your patient looks. Remember, your patient is bleeding to death until proven otherwise. And it’s your job to prove it. Fast!