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Measuring blood pressure

BLOOD PRESSURE
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The non-invasive ausculatory method is one of the most common ways of monitoring a patient's blood pressure

BLOOD PRESSURE
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The subject sits down and rests their arm on a table so the brachial artery is level with the heart.

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A sphygmomanometer cuff is wrapped around the subject's upper arm, just above the elbow and a stethoscope is placed on the hollow of the elbow, over the brachial artery as shown below.

Equipment
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Cuffs
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The cuff at the top is a thigh cuff. The cuff in the middle is an adult cuff. The cuff at the bottom is designed to fit a child.

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Most cuffs are marked with an O or an arrow. This should be placed near the artery

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Occupy 2/3 of arm length Alow 2 finger to pass between the cuff and arm

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Note how the ear pieces slant slightly in one direction. Make sure the ear pieces on the stethoscope are point away from you when you put them on.

A Grasp the bulb so that your thumb can easily access the valve.
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Turn the valve to the right to tighten it and pump up the cuff, turn it to the left to loosen to and deflate the cuff.

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Pump up the cuff until the sphygmomanometer reads 180 to 200. Loosen the valve to let a little of the air out. Listen for the first heartbeat, that is the top number. Continue to listen until there are no more heartbeats. The last beat you hear is the bottom number. Let the air all the way out and remove the cuff.

The Korotkoff sounds

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The Korotkoff sounds are the sounds heard through the stethoscope as the pressure cuff deflates. The sounds are first heard when the cuff pressure equals the systolic pressure, and cease to be heard once the cuff has deflated past the diastolic pressure.

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Phase 1
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The artery is completely occluded and no blood can flow through it. No sounds are heard above the systolic pressure. At the point where cuff pressure equals the systolic pressure, a sharp tapping sound is heard.

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The blood pressure oscillates between systolic and diastolic pressure. At systolic, blood to spurt through. diastolic the artery walls bang shut The closing shut of the artery walls that results in the tapping sound.

Phase 2
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This phase is characterised by a swishing sound, caused by the swirling currents in the blood as the flow through the artery increases If the cuff is deflated too slowly, the sounds vanish temporarily.

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This happens when the blood vessels beneath the cuff become congested, and is often a sign of hypertension The congestion eventually clears, and sounds resume. The intervening period is called the auscultatory gap.

Phase 3
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In this phase, there is a resumption of crisp tapping sounds, similar to those heard in phase 1. At this stage, the increased flow of blood is pounding against the artery walls.

Phase 4
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An abrupt muffling of sound. The blood flow is becoming less turbulent. Some medical practitioners choose to record this point as the diastolic pressure.

Phase 5
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Sounds cease to be heard all together. The blood flow has returned to normal and is now laminar. The pressure cuff is deflated entirely and removed.

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QUESTIONS?
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