Peripheral pulsations and blood pressure measurement

Peripheral pulsations and blood pressure measurement

1. Peripheral pulsation Dr. ABEER ABDELKAREEM

2. Peripheral pulsation Oxford Handbook of Clinical Examination and Practical Skills

3. Peripheral pulsation Oxford Handbook of Clinical Examination and Practical Skills

4. Radial artery Use the first and second fingers to feel just lateral to the tendon of the flexor carpi radialis and medial to the radial styloid process at the wrist. Brachial artery Feel at the medial side of the antecubital fossa , just medial to the tendinous insertion of the biceps .

5. Carotid artery Find the larynx, move a couple of centimeters laterally, and press backward medial to the sternomastoid muscle. Be sure not to compress both carotids at once, for fear of diminishing blood flow to the brain, particularly in the elderly.

6. Femoral artery The patient should be lying on a bed with their legs outstretched . Ask them to lower their clothes a little more, exposing the groin area (the area between the abdomen and the upper thigh .) The femoral pulsation can be felt midway between the pubic tubercle and the anterior superior iliac spine .

7. Popliteal artery This lies deep in the popliteal fossa and is surrounded by strong tendons. It can be difficult to feel and usually requires more pressure than you expect. With the patient lying flat and knees slightly flexed , press into the center of the popliteal fossa with tips of the fingers of the left hand and use the fingers of the right hand to add extra pressure to these.

8. Posterior tibial artery Palpate at the ankle just posterior and inferior to the medial malleolus. Dorsalis pedis This runs lateral to the exterior hallucis longus tendon on the superior surface of the foot between the bases of the first and second metatarsals.

9. Assessing Blood pressure B a t e s ’ g u i d e t o p h y s i c a l e x a m i n a t i o n a n d h i s to r y t a k i n g

10. Arterial blood pressure Arterial blood pressure is the pressure exerted by the blood as it flows through the arteries Systolic blood pressure is the pressure of blood in the arteries during contraction of the heart diastolic blood pressure is the pressure of blood in the arteries during relaxation of the heart

11. Types of sphygmomanometer

12. The patient should Avoid smoking, exercise or caffeine for 30 minutes before the blood pressure is taken The patient should sit quietly for at least 5 minutes in a chair with both feet flat on the floor and legs uncrossed . Check to make sure the examining room is quiet and comfortably warm. The arm selected should be without clothing or fistulas for dialysis. Palpate the brachial artery to confirm that it has a viable pulse. Position the patient’s arm so that it is slightly flexed at the elbow, and the brachial artery is at heart level roughly level with the 4th interspace . If the patient is seated, rest the arm on a table a little above the patient’s waist Center the inflatable bladder over the brachial artery. The lower border of the cuff should be about 2.5 cm above the antecubital crease. Secure the cuff. GETTING READY TO MEASURE BLOOD PRESSURE

13. Estimate the systolic blood pressure and add 30 mm Hg. (Palpatory method) To determine how high to raise the cuff pressure, first estimate the systolic pressure by palpation . As you feel the radial artery with the fingers of one hand, inflate the cuff until the radial pulse disappears . Read this pressure on the manometer and add 30 mm Hg . Deflate the cuff completely and wait 15 to 30 seconds.

14. Auscultatory method Now place the bell or the diaphragm of a stethoscope lightly over the brachial artery. Identify the systolic blood pressure Inflate the cuff rapidly again to the previously estimated systolic blood pressure Deflate it slowly at a rate of about 2 to 3 mm Hg per second. Note the level at which you hear the sounds of at least two consecutive beats. don’t allow the stethoscope to touch the cuff or clothing.

15. Identify the diastolic blood pressure Continue to lower the pressure slowly until the sounds become muffled and disappear . Then deflate the cuff rapidly to zero. Read both the systolic and the diastolic levels to the nearest 2 mm Hg. Wait 2 or more minutes and repeat . Average your readings. If the first two readings differ by more than 5 mm Hg, take additional readings. Blood pressure should be taken in both arms at least once. Normally, there may be a difference in pressure of 5 mm Hg and sometimes up to 10 mm Hg.

16. Importance of palpatory method 1- Used as the target for subsequent inflations 2- prevents discomfort from unnecessarily high cuff pressures. 3- It also avoids the occasional error caused by an auscultatory gap (a silent interval) that may be present between the systolic and the diastolic pressures. 4- An unrecognized auscultatory gap may lead to serious underestimation of systolic pressure (e.g., 150 instead of 200 ⁄ 98) or overestimation of diastolic pressure.

17. Definitions of Normal and Abnormal Levels. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure ( JNC8 ) recommended that hypertension should be diagnosed only when a higher than normal level has been found on at least two or more visits after initial screening.

18. Heart rate Normal ranges of pulse in adults from 60 to 100 beats per minute (BPM) A heart rate of fewer than 60 (BPM) qualifies as bradycardia. A heart rate of more than 100 (BPM) in adults qualifies as tachycardia. RESPIRATORY RATE Normal 12 – 20 / min Bradypnea ↓ 10 / min Tachypnea 25 / min

19. Procedure of BP measurement 1- Introduce your self , take patient consent 2- Clean the stethoscope earpiece and diaphragm with alcohol 3- Position : sitting position with forearm at heart level 4- Wrap The cuff above the elbow 2.5 cm above the antecubital fossa A- Put your fingers on radial artery , feel the pulse B- Close the valve and inflate the cuff till the point of disappear ( systole ) C- Deflate cuff 5- locate the brachial artery, position the stethoscope 6- Close the valve and inflate the cuff 30 above 7- Deflate the cuff slowly Detect the first sound (systole) Detect the point of disappear (diastole)

20. Korotkoff Sounds Definition Korotkoff sounds are blood flow sounds that healthcare providers observe while taking blood pressure with a sphygmomanometer over the brachial artery in the antecubital fossa. These sounds appear and disappear as the blood pressure cuff is inflated and deflated.