For Blood Pressure experts

[vc85]

Quick question for those who are great with auscultation of blood pressures. Is there an average on how many mmHg the third phase Kortikoff sounds (when they get really loud) are below the first sounds.

I'm trying to figure out if it is probable that a pt with a systolic blood pressure in the 180 mmHg range had the third phase sounds and significant needle jump around the 110 mmHg mark or if that would have happened earlier

 

[STXmedic]

I just palpate all of my blood pressures. Well, palpate the NIBP button...

 

[CALEMT]

Well, palpate the NIBP button...

Its a critical life or death skill thats taught nowadays.

 

[Alan L Serve]

Quick question for those who are great with auscultation of blood pressures. Is there an average on how many mmHg the third phase Kortikoff sounds (when they get really loud) are below the first sounds.

I'm trying to figure out if it is probable that a pt with a systolic blood pressure in the 180 mmHg range had the third phase sounds and significant needle jump around the 110 mmHg mark or if that would have happened earlier

I dunno. I've heard of people having big gaps between II and III but I am totally not sure what it represents. In fact I'm pretty sure it doesn't represent anything and instead you can ignore them and just focus on when you hear the first KABOOM (systolic) and then you hear the last KABOOM (diastolic).

 

[VentMonkey]

It's a vital sign, try not to over think it. It's one of several diagnostic clues to either a rabbit trail of nothingness or things to come.

Are they symptomatic along with this HTN? Then perhaps you got something. Otherwise the patient may simply be a non-compliant pt.

Not uncommon by any means.

 

[StCEMT]

I didn't know anything about a III phase....I too use NIBP skills quite often....if I don't use that, I palp them more than auscultating. I am generally happy enough just knowing the systolic to get a quick idea til I get a little more settled.

That being said, is there any particular reason you are wondering about how loud it all is? Seems like one of those things that would get filed under useless knowledge....

 

[SeeNoMore]

I am impressed you were taught (or took the time to learn about) the five Korotkoff sounds / phases. My EMS education (for both EMT and Paramedic) esentially began and ended with "listen for the first sound and then when it dissapears". And of course now I am an enthusiatic NIBP masher or better yet arterial waveform observer.

As for your question - yes isolated systolic hyerptension is real , but that implies that the diastolic pressure is normal. If the systolic blood pressure is 180 the diastolic pressure could be a number of values depending on the pt's underlying health and presenting condition. As far as I know there is not really an average difference (pulse pressure). Obviously it's about 40mmHg in a healthy patient with normal blood preussure , but the extent to which it changes or stays consistent is not the same for all patients.

 

[Akulahawk]

I just palpate all of my blood pressures. Well, palpate the NIBP button...

Just a couple of weeks ago, one of my fellow nurses had an NIBP machine not work correctly when taking a patient's blood pressure. It kept failing. I was asked to take a manual BP and it was absolutely easy. All 5 phases were clearly evident in that patient's BP... but I digress. I recorded the BP and did a little troubleshooting. It seems that the machine had been set to pediatric mode and therefore never inflated the cuff to a high enough pressure - the actual SBP was significantly higher than where the machine stopped. Once that was all fixed... all was good!