BP advice

[dradams]

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I need some advice on how to take an accurate blood pressure reading. It seems that the most common thing for inexperienced people to do is to falsly report a high BP (especially systolic). What is the proper technique for getting the most accurate reading?

 

[Medic_9]

- Ensure your stethoscope is placed properly on the inner crease of the arm.
- Support the elbow so that the arm is relaxed and that you can better control the pressure of the diaphragm on the skin. If i'm sitting I'll rest the patients elbow on my knee and control the arm that way. If i'm standing i'll tuck the person's arm under mine.
- I recommend learning how to do an accurate bp by auscultation before moving on to palpation.
- Lots and lots of practice. The more you do the faster and more accurate you will become.

I don't know what else to tell you to help out, you need to get someone in person to show you how.

Good Luck

 

[angel80]

The true way to do it is to feel for the patient's radial pulse while you are inflating the cuff. When the pulse disappears, that's approximately where the systolic BP is, then inflate another 25-30mmHg. At that point, let go of the wrist, position the stethoscope, and proceed to deflate the cuff slowly, while listening for the correct sounds. The most accurate reading is when you inflate the cuff about 25-30 mmHg above the systolic BP. If the cuff is inflated too much (like inflating up to 200 in a patient who's systolic is actually118), it will cause the BP to be elevated. Also, if the cuff is too small for the patient's arm, you will get a falsely elevated reading as well.

 

[PickyBicky]

original post corrected.

-PB

 

[trudub]

Nope she was right, cuff too small = elevated BP, cuff too large = low bp

 

[tiger_lily]

Medic_9 is right: It's all about practice! You will get comfortable with it with time. A few tips from my former life in EMS:
- Make sure your stethoscope is placed correctly - I find it helps if I palpate for the pulse first (in the inner elbow) and place my stethoscope directly over top.
- Feel for the radial pulse and inflate the cuff to 30 mmHg above where it disappears
- Make sure your patient is positioned well - the arm should be at approx. heart level - if it is hanging down when they're standing or really elevated when they're lying down it'll be off.
- Make sure your patient is relaxed and quiet. Moving around and even talking can show an elevated BP
- Remember that you are listening for tapping sounds - you'll get used to what correct sounds are. In some people, the tapping stops but you'll hear muffled sounds all the way down to zero - you want the number when the tapping stops and the muffled sounds begin (similarly with the systolic number - there can be muffled noises at the beginning too).
- Don't look at the jumping needle on the gauge - listen to the sounds! I saw a lot of newbies "cheat" this way, and it often isn't accurate.
- If you need to retake a BP, wait at least a minute until the second reading or switch to the other arm
- Oh, and make sure you fully deflate the cuff after you get your diastolic reading! Too many times I've been acting as the patient and either a) the cuff get inflated up to 250 mmHg (ow!), or b) it gets inflated above my systolic pressure correctly but then LEFT there when the person gets distracted by something or c) it gets left at my diastolic pressure because now that they have both numbers, they're done, right? 😉

Good luck! And remember, practice makes perfect. If you can hook up with someone who really knows what they're doing, that'd be best. Then you can compare BP readings and see how close you come. Also, if you can get a dual-stethoscope (a teaching stethoscope), that would be best because then you can both hear the same things at the same time, and you'll know exactly which sounds to be listening for.
Hope this helped 🙂

 

[Blade28]

The key element is having the correct BP cuff size.

 

[willow18]

Initially, you may have problems tuning out/distinguishing outside noise, especially in patients with a weaker/irregular pulse. It's good to look at the needle; it usually begins jumping about 8-15 points before you begin hearing the beats. Apply light but firm pressure with the stethoscope on the medial side of the inner elbow. Cuff size matters, of course, but there are only 3-4 sizes, and most patients use the regular adult or peds.

The 'art' of BP taking is going out of business anyway, as soon as the portable BP machines become cheaper.

 

[Medic_9]

The 'art' of BP taking is going out of business anyway, as soon as the portable BP machines become cheaper.

I disagree. Many times those automatic BP's can be unreliable when bouncing around in the back of the ambulance. 😎 Or when the person moves, or when the person decides to keep moving their hand / fingers 😡 (why I have no idea).

I always like the option of double checking with a manual BP.

 

[AmoryBlaine]

Doesn't anyone else just write down 132/88? It is so much faster than all this nonsense...

 

[Medic_9]

Doesn't anyone else just write down 132/88? It is so much faster than all this nonsense...

LOL 🙂

 

[dradams]

Some of my classmates do just that. It is pretty scary.

 

[willow18]

I disagree. Many times those automatic BP's can be unreliable when bouncing around in the back of the ambulance. 😎 Or when the person moves, or when the person decides to keep moving their hand / fingers 😡 (why I have no idea).

I always like the option of double checking with a manual BP.

When they move their hands/fingers, or if they clench, your manual BP is gonna be off as well, from my experience anyway.

 

[dradams]

This is really great advice.

 

[Medic_9]

When they move their hands/fingers, or if they clench, your manual BP is gonna be off as well, from my experience anyway.

Yes but when you do a manual you are well aware they are doing it. When you start to use the automatic you start to multitask and then you don't realize they are doing it until it's either done or during your next BP.

🙄 Stupid People