# Checking Blood Pressure manually



## TacEMT (Mar 10, 2012)

I am confused when it comes to checking blood pressure, as I have not done this in a while. I am confused as to when to record the readings so is this correct? When getting readings, you record the systolic pressure when you start hearing the thump, and record the diastolic when the thump ceases. Right? Whats confusing me is even when I can no longer hear the thump, I can see the dial still flick on each beat, so although I can't hear it, I know its still feeling the beat. So do you record findings based on what you hear, or when the dial starts and stops flicking? The dial usually continues to flick way after I stop hearing it.


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## DesertMedic66 (Mar 10, 2012)

Only off of what you can hear. The dial will bounce from any movement that the patient does. A small muscle flex will cause the needle to bounce. Bumps in the road will make the needle bounce, etc.


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## TacEMT (Mar 10, 2012)

Okay thanks, also I am recently getting really high readings on people, like 140 over 100, is this the new normal? I keep thinking I am doing something wrong. And sometimes I don't hear the thump at all, and its a dead quiet room. Should I go off the dial movements then?


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## DesertMedic66 (Mar 10, 2012)

Dial movements are never accurate. 

There are alot of reasons you could be getting a high reading (patient has a high b/p, the steth is not working good, you don't have a good enough seal in your ears to the steth buds, your steth could be in the wrong place, etc). 

My B/P always runs low, normally 108/72. When I have my EMT students taking my B/P I will purposely flex my arm so the dial is bouncing. So when they give me a reading of 176/98 I know they pulled that number out of their butt and were using the dial movement. 

The dial movement is never accurate. If you need a B/P badly and can't hear anything then palp it.


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## Akulahawk (Mar 10, 2012)

The folks above have it right. Another thing to remember is that if your cuff is too small, you can get readings that are higher than what the actual reading should be. Good stethoscope head placement also makes a difference. If it is in the wrong place, you will miss the softer first and last sounds.


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## Brandon O (Mar 10, 2012)

The visible bouncing of the needle is NOT an accurate measurement of the blood pressure, but it IS an accurate depiction of the pulse rate, for whatever that's worth.


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## DesertMedic66 (Mar 10, 2012)

Brandon Oto said:


> The visible bouncing of the needle is NOT an accurate measurement of the blood pressure, but it IS NOT an accurate depiction of the pulse rate, for whatever that's worth.



Fixed that for you. The patients pulse is not the only thing that makes the needle move. See posts above for other examples of things that make the needle move that are not the pulse.


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## Brandon O (Mar 10, 2012)

Yes, it can bounce for any reason including meteor impacts. But the regular underlying pulsation should be discernible unless artifact is really extreme.

In fact, I would say that learning to filter out the regular "beat" of a pulse (or respirations, or what have you) is one of the most useful skills in taking vitals, because it lets you "read through" whatever other bumps, pings, or bounces the environment piles around it. (That's why irregular pulses, such as in A-fib, can be such a bother.)


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## Bulldog Medic Student (Mar 11, 2012)

When you put the cuff on pump it up a couple of times. Palpate just below the cuff for the brachial artery. Put the scope right on top of it. Pump up till you dont hear the beat anymore, then pump 20 mm more. Let the air out slowly and you will here the systolic crystal clear then just pay attention and you'll find the bottom. Make sure the buds are in good. Get a good scope, but not a cardiology. Yes most people will tell you , you dont need it. Look on their neck and you'll see a Littman.


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## TacEMT (Mar 11, 2012)

Thanks for the answer everyone. I will admit I am using a cheap blood pressure cuff, and cheap steph, one that I bought at Walgreens together for like 12 dollars I think. Definitely not something for patient use but for home use, but its all I got now. The problem is I am hearing very faint thumps. In class, everyone wore short sleeves, but now I am checking blood pressures over people's sleeves. Is this bad practice? I am assuming thats why I am barely hearing the thumps sometimes.


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## Akulahawk (Mar 11, 2012)

You should be taking blood pressures against bare skin, not through a shirt or anything like that. The way you were doing it, through a shirt, or a sweater, makes getting the reading very difficult.


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## Hunter (Mar 11, 2012)

TacEMT said:


> now I am checking blood pressures over people's sleeves. Is this bad practice? I am assuming thats why I am barely hearing the thumps sometimes.



Stop this right now, take a second to roll up someones sleeve you can put the cuff on over some thin layers of clothing but not the stethoscope. It's the same logic as when you check lung sounds or heart tones, the less clothing/skin/muscles you have in between the stethoscope and what you're trying to hear the better. 

Question, your employer doesn't provide you with at least a BP cuff?


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## TacEMT (Mar 11, 2012)

Hunter said:


> Question, your employer doesn't provide you with at least a BP cuff?



Nope I am not provided with a BP cuff, steph, light to check pupils, or any other special equipment beyond a first aid kit. No OPA, NPA, or BVM either.

I'll make sure I take blood pressures without sleeves for accurate readings.


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## rwik123 (Mar 11, 2012)

TacEMT said:


> Nope I am not provided with a BP cuff, steph, light to check pupils, or any other special equipment beyond a first aid kit. No OPA, NPA, or BVM either.
> 
> I'll make sure I take blood pressures without sleeves for accurate readings.



Do you mind sharing your job position? Your obviously not on an ambulance. What do you do?


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## hibiti87 (Mar 11, 2012)

you can check a bp over clothing, but only palpate it using the radial pulse, i normally do it to get a quick vague baseline if the patient has a ton of clothes on, then proceed into auscultation during my detailed assessment.


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## TacEMT (Mar 12, 2012)

rwik123 said:


> Do you mind sharing your job position? Your obviously not on an ambulance. What do you do?



I don't work for any emergency medical service, and my EMT duties are considered specialized training, though I don't get EMT equipment. I do have another primary job duty. However the the EMT title is vested on me so I do respond to any medical issues that get reported to us, but like other normal citizen, I would request an ambulance if its a serious case.


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## mycrofft (Mar 12, 2012)

TacEMT, to act as an EMT you probably need a medical director. Watch out. Employers will use your ego and self-confidence to get you to act as a tech without the proper equipment and backup.

Taking BP with the steth head on top of clothes: not a standard, the time spent doing it is the time you could use to cut a window in the sleeve with your shears or ask them to pull that arm out of the sleeve. Rolling a sleeve up tightly can jigger your readings.
Cuff over sleeve: ok if the sleeve is not puffy. I'v slid the scope up the sleeve and put the cuff around the sleeve and subsequent readings were very close.

Pulse equals needle vibration: not with irregular and weak pulses.

Oddly high readings or low readings: research "Kortokoff sounds" or the term "Kortokoff drop-offs". 

Manual BP is a baby step into EMT-B or first responder even. Better get back on the books and get mentored, or take the classes over.


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## TacEMT (Mar 12, 2012)

mycrofft said:


> TacEMT, to act as an EMT you probably need a medical director. Watch out. Employers will use your ego and self-confidence to get you to act as a tech without the proper equipment and backup.
> 
> Taking BP with the steth head on top of clothes: not a standard, the time spent doing it is the time you could use to cut a window in the sleeve with your shears or ask them to pull that arm out of the sleeve. Rolling a sleeve up tightly can jigger your readings.
> Cuff over sleeve: ok if the sleeve is not puffy. I'v slid the scope up the sleeve and put the cuff around the sleeve and subsequent readings were very close.
> ...



I appreciate your information and I am aware that my EMT skills are a bit rusty. Its clear from the posts that it's best that I take blood pressure over bare skin. Its been a while since I finished EMT training and have not been active in EMS work since. I am looking into continuing education classes. 

However, I can assure you that my employer is not using me. We have several cross trained EMTs, and all of us are at least state certified. Some of the older guys aren't nationally certified because it wasn't required when they got initially certified. Because the EMT certification is only a collateral duty, the standard operating procedures for medical response is the same as those that are not EMTs. Basically we respond to medical calls like anyone else, and we request an ambulance when needed since we don't carry standard EMS equipment. In other words, we have the EMT designation, but we don't actually "work" as EMTs. Because we are not an official emergency medical service, we do not have a medical director. If a situation requires this level of decision making, we will call for an ambulance.


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## mycrofft (Mar 12, 2012)

Ah, all our employers use us, that's why we get paid! Good luck, the tips above are pretty sufficient.


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