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Blood Pressure Measurement

Discussion in 'General Practitioner' started by Ghada Ali youssef, Jan 12, 2017.

  1. Ghada Ali youssef

    Ghada Ali youssef Golden Member

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    Blood pressure measurement occasionally shows up as an OSCE station. It’s important you’re familiar with this relatively simple procedure if you want to look slick and score well on the station. There’s often a significant number of marks available for communication skills when explaining the procedure to the patient, so don’t overlook the importance of this aspect of the station. Check out the blood pressure measurement mark scheme here.

    Gather equipment
    Before you see the patient ensure you have the appropriate equipment to perform blood pressure measurement.

    1. Stethoscope
    2. Sphygmomanometer:

    • Ensure you have an appropriately sized cuff
    • A cuff that’s too small may overestimate BP
    • A cuff that’s too large will underestimate BP
    Introduction
    • Wash hands
    • Introduce yourself – state your name and role
    • Confirm patient details – name / DOB
    • Explain the procedure:
    “I will be measuring your blood pressure“

    “This will involve inflating a cuff around your arm briefly and listening to your pulse with a stethoscope“

    “It shouldn’t be painful, but it may feel a little uncomfortable temporarily“
    • Check understanding “Does everything I’ve said make sense? Do you have any questions?“
    • Gain consent – “Are you happy for me to record your blood pressure?“
    • Check if the patient has a preference as to which arm to use – e.g. avoid arms with post mastectomy lymphoedema
    Attaching the cuff
    1. Ensure the cuff size appears appropriate
    2. Wrap the cuff around the patient’s upper arm
    3. Line up the cuff marker with the brachial artery – slightly medial to the the biceps brachii tendon

    62405ff14b49d9fda3e4fd0f0ccb48fc.jpg
    Ensure cuff size is appropriate

    8772fc10fe37ce1cf7b0b4669802daed.jpg
    Ensure arrow aligned with brachial artery

    Measuring the blood pressure

    - Estimate an approximate systolic blood pressure

    1. Palpate the radial pulse
    2. Inflate the cuff until you can no longer feel this pulse
    3. Note the reading on the sphygmomanometer
    " This is a rough estimate of the systolic blood pressure "

    dcbfae9636a3aa54614b074bf2f3e984.jpg

    Palpate radial artery
    4d8ca50aecfd42f0661de93aeb975739.jpg
    687d55612439bda01fc021019a1c5a46.jpg

    - Measure the blood pressure accurately
    1. Place your stethoscope’s diaphragm over the brachial artery
    2. Re-inflate the cuff to 20-30 mmHg above your approximate systolic BP measured earlier
    3. Begin to slowly deflate the cuff – around 2-3 mmHg per second
    4. Listen carefully and at some point you will begin to hear a thumping pulsatile noise:

    • This is known as the 1st Korotkoff sound
    • The pressure at which this 1st sound is heard is the systolic blood pressure
    5. Continue to deflate the cuff, continuing to listen until the sounds completely disappear:
    • The point at which you hear the last sound is referred to as the 5th Korotkoff sound
    • This is the diastolic blood pressure
    6. If the patient is noted to be hypertensive (>140/90) or hypotensive you should re-check the blood pressure after 2 minutes to confirm this is an accurate result (use the other arm and reconsider if the cuff size is appropriate)

    97e890c4b87ade726122c934d7f98243.jpg
    Palpate brachial artery

    e53985b93414167810298ef2382a5a35.jpg
    Place stethoscope over brachial artery

    bbaac603eb6106b3d7da2b8491edf7b0.jpg
    Re-inflate cuff

    dc8ef5c3f601229e2f7c41d545cb1fb9.jpg
    Slowly deflate cuff

    124fcd072087ab6e43cd667d1149eed9.jpg
    Listen for 1st Korotkoff sound - note SBP

    3f1ef3c5f4f1507ca49847bb38bcdbce.jpg
    Listen for 5th Korotkoff sound - note DBP

    fd2e2ef39a37b61b57b0206c344cd8c5.jpg Remove cuff

    To complete the procedure
    • Document the recordings in the patient’s notes.
    • Explain the need for follow up if hypertensive – BP monitoring / antihypertensives
    • Thank patient
    • Wash hands
    Source
     

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