Handout for the practical on blood pressure measurement

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Information about Handout for the practical on blood pressure measurement
Health & Medicine

Published on March 18, 2014

Author: samankaru

Source: slideshare.net


For first year medical/dental students

1 Cardiovascular System Handout for the practical on Measurement of Blood Pressure. Objectives 1. Students should be able to explain the physiological basis of using the mercury sphygmomanometer to measure the blood pressure. 2. Students should be able to measure the blood pressure using a mercury sphygmomanometer. Blood Pressure Systolic Blood Pressure (SBP) : Maximum pressure produced in the artery by the left ventricle during systole. Diastolic Blood Pressure (DBP) : Pressure in the artery at the end of the diastole ( just before the next systole) Normal BP range: For adults - 120/70 mmHg For children - close to the lower limit of the above range For elderly - close to the upper limit of the above range Measurement of BP 1. Direct method - Mercury manometer (if canular is inserted in to an artery the arterial blood pressure can be directly measured by mercury manometer) - Optical manometer - Electronic manometer 2. Indirect method - Sphygmomanometer - Electronic blood pressure monitors

2 Using a Sphygmomanometer Mercury Gauge Tubing Cuff (Bladder : The part of the cuff which can be filled with air) Release valve(Screw) Hand bulb Palpatory Method Patient should be sitting or lying at ease Cuff on the forearm and the patient’s heart should be at the same level and the observer’ eyes and the upper limit of the mercury column should be at the same level. Apply the cuff on the upper arm 2.5cm above the cubital fossa and it is important to choose a cuff which is 2/3 of thelength of the forearm. Locate the radial pulse. Inflate the cuff about 30mmHg about the point of disappearance of the radial pulse. Release the pressure in the cuff gradually and palpate the reappearance of the radial pulse. The pressure at which it is first palpable is the systolic blood pressure.

3 Auscultatory method Rapidly inflate the cuff 30mmHg above the systolic blood pressure taken by the palpatory method. Place the stethoscope lightly over the brachial artery in the cubital fossa. Release the valve and lower the pressure by 2-3mmHg/sec at a time while auscultating over the cubital fossa. Auscultation over the brachial artery reveals 5 phases of Korotkoff sounds as the cuff is deflated which are produced by the turbulent flow in the brachial artery. Phase 1 : the first appearance of the sound (SBP ; when the systolic BP in the artery is just exceeding the cuff pressure a spurt of blood passes through the artery with each heart beat at the peak of systole and this intermittent turbulent flow produces a tapping sound.) Phase 2 and 3 : increasing loud sounds (Staccato quality :there is turbulent intermittent flow during a part of diastole.) Phase 4 : abrupt muffling of the sounds (when the cuff pressure is near the diastolic pressure there is continuous turbulent flow through mildly constricted vessel.) Phase 5 : disappearance of the sound(DBP ; the streamline blood flow through the unconstricted artery) Phase 5 is better measure of DBP than phase 4 (phase 5 correspond more closely with the directly measured DBP and its identification is less subjective.), but DBP equals phase 4 in adults after exercise, in children, hyperthyroidism and aortic insufficiency. The BP measured by palpatory method is 2-5mmHg lower than the auscultatory method. It is wise to measure the blood pressure in both sides and compare them, when examining an individual for the first time. If there is a significant difference it is suggestive of vascular obstruction. Activities Measure the blood pressure using the sphygmomanometer Record the SBP and DBP for all students in the batch. Calculate the mean and SD for SBP and DBP of the entire batch

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