# Brachial Artery and Blood Pressure



## wadford (Feb 18, 2011)

I really hope this is the right section to post this in. So we are in the patient assessment module in my EMT-B class. And we are doing vital signs. My question is this, what do you do when you have to take a patients bp and you can't feel the pulse in the brachial artery? Given that the "pt" is completely healthy, no trauma ect. For the sake of this post, the pt is a class mate. It's really irritating, because I can feel my pulse there, and I was able to find another classmates brachial pulse, but I could not find it in the classmate I was assigned to. So what do you do when you need a bp and can't feel (or hear with a stethoscope) the pulse at the brachial artery?


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## bigbaldguy (Feb 18, 2011)

Begin CPR? 
Have you tried his other arm? Are you using the school supplied stethoscope maybe buy your own the scopes we had were crap, I ordered my own BP cuff off of amazon and everyone in the class used it and my scope (nothing too fancy just a decent one). You might also pump the cuff up and wait a little longer than normal before releasing the pressure as this seems to make it a little easier to hear the pulse kicking in again.


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## wadford (Feb 18, 2011)

I tried on both of this guys' arms! Nada. Yeah the scopes and the cuff we had were supplied by the school and were a little worse for the wear. I got mine scope in last week so I'll be taking it to class with me next time.


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## wadford (Feb 18, 2011)

my scope, sorry, functioning on two hours of sleep and three pots of coffee.


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## Anjel (Feb 18, 2011)

If it comes to where you seriously just can't absolutely hear it on a patient or feel it for that matter. You can always do systolic over palpation. 

If you cant find the radial. Then you are in trouble.


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## emt_irl (Feb 18, 2011)

a tip i found works good in hard to palpate brachial pulses is get them to tense their muscles(biceps), just below/up and under the muscle you should feel it beating away. then when your more comfortable taking bp's you nearly automaticlly know where to put the steth without needing to palpate a pulse first


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## wadford (Feb 18, 2011)

Thanks for all the great advice, I will definitely try having him flex his biceps! I'm going to get a bp cuff so I can practice (my poor family lol) when I'm not in class.


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## WTEngel (Feb 18, 2011)

Use the NIBP on your LifePak or other monitor...

Taking your own BP is so mid 90's!

But seriously... These are all good tips. Another thing to remember is that when the needle begins bouncing, you should be able to hear the systolic pressure. So as you deflate, when you see the needle begin to move up and down, slow or even stop the deflation and you can adjust your bell placement until you can hear the pulsation.

Now, two things I will point out. Don't take this above tip to mean that when the needle starts bouncing, that indicates your systolic, because it doesn't. First auscultated pulsation is systolic. Second, this method is really only good for training to help you adjust bell placement until you get the feel for it to be able to do it correctly with consistency.

Hope this helps...


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## Shishkabob (Feb 18, 2011)

Well, considering you typically don't palpate the brachial on anything but young peds, I'd move on and try to palpate the radial


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## frankiemuniz01 (Feb 18, 2011)

You might also pump the cuff up and wait a little longer than normal before releasing the pressure as this seems.


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## sop (Feb 18, 2011)

Check to make sure that you are pumping the cuff tight enough and that the stethoscope is working.


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## Veneficus (Feb 18, 2011)

wadford said:


> I really hope this is the right section to post this in. So we are in the patient assessment module in my EMT-B class. And we are doing vital signs. My question is this, what do you do when you have to take a patients bp and you can't feel the pulse in the brachial artery? Given that the "pt" is completely healthy, no trauma ect. For the sake of this post, the pt is a class mate. It's really irritating, because I can feel my pulse there, and I was able to find another classmates brachial pulse, but I could not find it in the classmate I was assigned to. So what do you do when you need a bp and can't feel (or hear with a stethoscope) the pulse at the brachial artery?



Press harder.


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