19. bp measurement (dr yap)

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unikl rcmp pcm yfn Ref: 1. Malaysian Clinical Practice Guidelines on Management of Hypertension (3rd Edition) Feb 2008 2. http://www.studentconsult.com/content/default.cfm? ISBN=0443074046 Measurement of BP using a sphygmomanometer: Patients should be adequately rested (> 5 minutes) and seated with their arms supported. The cuff and the mercury reservoir should be at the level of the heart. The SBP should be estimated initially by palpation. While palpating the brachial/ radial artery, the cuff is inflated until the pulse disappears. The cuff should then be inflated to a further 20 mmHg. The cuff is then slowly deflated and the pressure at which the pulse is palpable is the estimated SBP. Remember to deflate the cuff completely before the auscultation method. The SBP and DBP are then measured by auscultation. Apply the cuff to the upper arm with the centre of the bladder over the brachial artery. The stethoscope should not be placed under the cuff. The bladder is again inflated to 20 mmHg above the previously estimated SBP and the pressure reduced at 1-2 mmHg per second whilst auscultating with the stethoscope. The point at which repetitive, clear tapping sounds first appears (Korotkoff Phase I) gives the SBP. The complete disappearance of sound (Korotkoff Phase V) should be taken as the DBP.

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Malaysian Clinical Practice Guidelines on Management of Hypertension (3rd Edition) Feb 2008

unikl rcmp pcm yfn

Ref:

1. Malaysian Clinical Practice Guidelines on Management of Hypertension (3rd Edition) Feb 2008

2. http://www.studentconsult.com/content/default.cfm?ISBN=0443074046

Measurement of BP using a sphygmomanometer:

Patients should be adequately rested (> 5 minutes) and seated with their arms supported.

The cuff and the mercury reservoir should be at the level of the heart.

The SBP should be estimated initially by palpation.

While palpating the brachial/ radial artery, the cuff is inflated until the pulse disappears. The cuff should then be inflated to a further 20 mmHg. The cuff is then slowly deflated and the pressure at which the pulse is palpable is the estimated SBP.Remember to deflate the cuff completely before the auscultation method.The SBP and DBP are then measured by auscultation.

Apply the cuff to the upper arm with the centre of the bladder over the brachial artery. The stethoscope should not be placed under the cuff.The bladder is again inflated to 20 mmHg above the previously estimated SBP and the pressure reduced at 1-2 mmHg per second whilst auscultating with the stethoscope.The point at which repetitive, clear tapping sounds first appears (Korotkoff Phase I) gives the SBP.

The complete disappearance of sound (Korotkoff Phase V) should be taken as the DBP.

In some groups, e.g. anaemic or elderly patients, the sounds may continue until the zero point. In such instances the muffling of the repetitive sounds (Korotkoff Phase IV) is taken as the diastolic pressure. The point of muffling is usually higher than the true arterial diastolic pressure. If Korotkoff Phase IV is used, this should be clearly recorded.

BP should be measured in both arms and the higher reading is taken.If the difference in BP between the two arms is >20/10 mmHg, there may be an arterial anomaly which requires further evaluation.

The BP should be taken both lying and at least one minute after standing to detect any postural drop, especially in the elderly and in diabetics.On rising, the BP will transiently rise and then fall. A systolic drop of >20 mmHg is considered a significant postural drop.http://www.studentconsult.com/content/default.cfm?ISBN=0443074046

Examination sequence Rest the patient for five minutes

In ambulant patients, measurements are normally made with the patient seated. Either arm can be used.

Support the patient's arm comfortably at about heart level.

Apply the cuff to the upper arm with the centre of the bladder over the brachial artery.

Palpate the brachial pulse.

Inflate the cuff until the pulse is impalpable. Note the pressure on the manometer. This is a rough estimate of systolic pressure.

Now inflate the cuff another 10 mmHg and listen through the stethoscope over the brachial artery.

Deflate the cuff slowly until regular sounds are first heard. Note the reading to the nearest 2 mmHg. This is the systolic pressure.

Continue to deflate the cuff slowly until the sounds disappear.

Record the pressure at which the sounds completely disappear as diastolic pressure. Occasionally muffled sounds persist and do not disappear, in which case the point of muffling is the best guide to the diastolic pressure

http://www.heartfoundation.org.au/SiteCollectionDocuments/HypertensionGuidelines2008to2010Update.pdfGuide to management of hypertension 2008

Assessing and managing raised blood pressure in adults

Updated December 2010National Heart Foundation of Australia.Common errors in BP measurement

The following errors can contribute to undertreatment of hypertension: cuff placed over clothing

incorrect cuff size

worn cuff

inaccurate sphygmomanometer (e.g. not serviced regularly, not validated correctly)

arm elevated above heart

failure to check that both arms give comparable readings (e.g. at initial visit)

patient not rested before measurement

patient talking during measurement

failure to palpate radial pulse before auscultatory measurements (results in failure to detect auscultatory gap)

deflating the cuff too quickly (> 23 mmHg/ beat, whether using a mercury or digital

sphygmomanometer)

re-inflating the cuff to repeat measurement before it has fully deflated

rounding off actual reading by more than 2 mmHg when recording measurement

taking a single measurement.