Blood Pressureand Pulses

Measuring Blood Pressure

Task

Estimate systolic blood pressure by palpation. Measure systolic and diastolic blood pressure by auscultation

Preparation – 4 marksPalpation – 2 marksAuscultation – 4 marks

Setting upAlcohol Gel

Clean your handsMake it visible to the examiner

Introduce yourself“Hello. Good morning. My name is YOUR NAME. I’m a first year

medical student from University of Manchester”

Confirm“May I please confirm your name?”“How would you like me to call you today?”

Setting up (cont’d)

Informed Consent – explain what is involved EXPLAIN

“Alright PATIENT NAME. I have been asked to check your blood pressure. This will involve me putting this cuff around your arm and inflating it”

“This might feel a bit tight but it shouldn’t hurt”“I will inflate the cuff twice, or more if needed”“If at anytime you feel uncomfortable please let me know”

CONSENT“Is that okay with you?”“Do you have a preference as to which arm I use?

Check : IV lines / cannulasFemale pt. ask for birth control implants

Preparation“ Could you please roll up your sleeves to about here” (show

the patient how up you’d like them)

“would you like any help with that?”

Check Equipment Sphygmomanometer

Cuff is fully deflatedDial is at zero

StethoscopePut the stethoscope on with the earpieces pointing forwardsGently tap the diaphragm and make sure you can hear a sound, if

you can’t then turn the tap on

Preparation (Cont’d)Make sure the Sphygmomanometer is away from patient’s

view

Look for brachial arteryRest Pt. arm on the benchAsk them to bend their elbowFeel for the Biceps tendon Brachial artery medial to tendon

Deflate the cuff and wrap it around pt. arm (according to the arrow)

Estimating Systolic BPTo examiner: “ I will first get an estimate for the Pt. systolic

blood pressure by palpating for their radial pulse”

Find Pt. radial pulseLocated lateral of forearm

Inflate the cuffUp to 200mmHgUsually, up to this point the pulse is no longer palpable

Deflate the cuff slowlyTo the point where the pulse becomes palpable againThis is your estimated systolic blood pressure

Estimating Systolic BP

Report: “The patient’s systolic blood pressure is ______ mmHg.

Systolic & Diastolic BPMake the sure the sphygmomanometer is at 0.

Put the stethoscope onPlace the diaphragm on patients brachial artery

located on the upper arm medial to the humerus

Inflate the cuff 30mmHg above your estimated systolic pressure value

Deflate the cuff slowly First sound you hear = systolic pressure When this sound disappears = diastolic pressure

Systolic & Diastolic BP

Report: “The patient’s systolic blood pressure is ______ mmHg and diastolic pressure is ______ mmHg, accurate up to 2 mmHg”

Pulses Examination

TaskShould be able to locate and count any two of

the following pulses: carotid temporalfacialbrachialradialulnarposterior tibial dorsalis pedis

Location and accurate measurement of each pulse – 4 marks

Carotid Pulse

Located in the Neckmedial to sternocleidomastoid muscleCarotid artery

Feel for it on one side only!

Image 1: How to feel for the pulse Image 2: Anatomy of carotid artery

Temporal Pulse

Located on the temple boneDirectly infront of the earSuperficial Temporal Artery

Feel for it on one side only!

Image 1: How to feel for the pulse Image 2: Anatomy of temporal artery

Facial Pulse

Located on the Mandible (lower jawbone) on a line with the corners of the mouthFacial artery

Feel for it on one side only!

Image 1: How to feel for the pulse Image 2: Anatomy of facial artery

Brachial Pulse

Located on upper armMedial to humerusBrachial Artery

Image 1: How to feel for the pulse Image 2: Anatomy of brachial artery

Radial Pulse

Located on the lateral of the wristRadial Artery

Image 1: How to feel for the pulse Image 2: Anatomy of radial artery

Ulnar Pulse

Located on the medial of the wristUlnar Artery

Image 1: How to feel for the pulse Image 2: Anatomy of ulnar artery

Posterior Tibial Pulse

Located on the medial side of ankle2cm inferior and 2cm posterior to the medial malleolusPosterior Tibial Artery

Image 1: How to feel for the pulse Image 2: Anatomy of posterior tibial artery

Dorsalis Pedis Pulse

Located on the top of the foot Immediately lateral to the extensor hallucis longusDorsal Pedis Artey

Image 1: How to feel for the pulse Image 2: Anatomy of dorsal pedis artery

Thank youQuestions?