# Having a little trouble with taking blood pressure



## JayConde (Jan 22, 2010)

I finished the practical skills test about 6 weeks ago, a week after i finished my EMT class and I just passed the NREMT exam but i have not done blood pressure in a while  i feel like i never fully got it. I want to apply already with an ambulance company but I do not want to go in there not being able to perform something as simple as blood pressure. I try to practice at home with family members but sometimes is like i cant hear the pulse. Any tips or advice ?:unsure:


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## Shishkabob (Jan 22, 2010)

Try to palpate for a bp first.  Put the cuff on, then put your finger over their radial pulse, then pump the cuff until the pulse can no longer be felt.  Slowly release the air until you feel the pulse again, and that's your palpated bp.


Then, do the same thing, but like a normal bp check with the stethoscope bell on the crease of the elbow.



It takes practice to get used to it... so try it on a bunch of different people.


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## JayConde (Jan 22, 2010)

thanks just that one of the paramedics in the classwas telling us to put the stethoscope like on the medial side of the arm right over the brachial but i have also seen videos where they put it on the crease although sometimes i cannot hear anything when I do put it there. do you know of any online video that might show more precise where I should do it (not that your explanation wasnt good)


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## Shishkabob (Jan 22, 2010)

Your best bet is to just move the stethoscope around someones arm until you can hear the beat, as everyone is different and it will never be in the same area.


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## Melclin (Jan 22, 2010)

Do you locate the brachial pulse first?

Putting the stethoscope right over the brachial artery is how we were taught to do it. Sometimes I find if you aren't directly above it, and just in the crease of the elbow, I find it can sometimes be a little harder to hear. 

Also, make sure that if you have a stethoscope with a selectable bell/diaphram, that the scope is switched to diaphram. 

Other than that its just a matter of practicing a lot, on lots of different people as far as I can see.

EDIT: I see a bit happened while I was away from the computer. Yeah you want to locate the brachial pulse. I'm sure there are diagrams a plenty on the web.


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## JayConde (Jan 22, 2010)

Melclin said:


> Do you locate the brachial pulse first?
> 
> Putting the stethoscope right over the brachial artery is how we were taught to do it. Sometimes I find if you aren't directly above it, and just in the crease of the elbow, I find it can sometimes be a little harder to hear.
> 
> ...



I usually always find the brachial pulse but i find it harder to feel it the further I go down towards the elbow. And I do not want to leave the stethoscope directly under the cuff because I have heard it can give you a wrong reading
Also I might buy a new stethoscope the one i have is really sensitive to like rubbing sounds and when I listen to the pulse I am getting all kinds of background noises along with it


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## joeshmoe (Jan 22, 2010)

How is your hearing? I've got ringing in my ears (tinnitus) as a souvenir of my time in the Marines, so taking blood pressure and ascultating lung sounds isnt always the easiest thing for me either. Just practicing and making sure u have the stethoscope right over the brachial helps. Blood pressure by palpation is something u should practice a lot too, as BP by ascultation in an ambulance rolling down the road isnt the easiest thing to do.
Also the quality of the stethoscope may make a difference.


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## JayConde (Jan 23, 2010)

i have no kind of ear problem. I am just going to practice as much as i can from now until i apply


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## themuffin101 (Jan 23, 2010)

have you tried using an electric scope? it amplifies the sound and is very easy to  use...but a good quality one might cost you a couple hundred. i have heard good things about them


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## 41 Duck (Jan 23, 2010)

Sounds like (and forgive if I'm wrong) this is a gentleman who is having difficulty obtaining a blood pressure reading, and is fairly new at performing the procedure.  Therefore, my suggestion would be to practice your technique before dropping hundreds of dollars on a stethoscope right now.  

All the superior acoustics in the world don't mean a thing if the desired sound is unable to be auscultated due to poor placement.  You don't need a six hundred dollar Bose scope to hear blood pressure, nor do you need a Littman Cardio III.  A thirty-dollar ADC will do just fine (I'm having a flashback; didn't Rid go off on this a year or so ago?).  

Without being there to see what you're doing, it's difficult, at best, to suggest a solution, but I often see newer providers rushing the procedure (they think I'm grading them on speed, or something--I'm not), or placing the diaphragm in the wrong place (I tell them to use the tendon as a landmark, the artery is usually directly medial to it).  If you're having difficulty in having enough room to place both the cuff and your scope, perhaps try a smaller cuff size, or place the cuff higher.  

Comes down to practice.  Keep at it, and you'll figure it out.  Best of luck to you.


Later!

--Coop


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## JayConde (Jan 23, 2010)

Thanks. I am getting a little better at it  i just do not want to prolong my time to apply any longer


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## swindlman (Jan 24, 2010)

JayConde said:


> I finished the practical skills test about 6 weeks ago, a week after i finished my EMT class and I just passed the NREMT exam but i have not done blood pressure in a while  i feel like i never fully got it. I want to apply already with an ambulance company but I do not want to go in there not being able to perform something as simple as blood pressure. I try to practice at home with family members but sometimes is like i cant hear the pulse. Any tips or advice ?:unsure:



First, after you put the BP cuff on the Pt's arm palpate the brachial pulse just below the lower edge of the cuff at the elbow joint. That is where you put your stethoscope, you are almost guaranteed to hear it. Rather than just guessing and not finding it with your older and obese Pt's.  

Second, try using the bell of the stethoscope instead of the diaphragm. It will block out more the the ambient background noise. 

Third, Make sure that you have the ear tubes of the stethoscope correctly in your ears. They should be at an angle and pointing forward into your ear canals. If you aren't doing this, you wont be hearing much of anything.


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## CAOX3 (Jan 24, 2010)

I would agree practise.

One more point of advice, if asked while working to take one and you cant get the pressure dont make up numbers admit you cant get it.  

Good luck.


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