# Blood pressure question



## sra (Feb 7, 2013)

When taking blood pressures ive noticed that the needle on the gauge "jumps" starting around the systolic and stops around the dystolic. Sometimes I just can't hear the sounds at all but I can see the "jumping" needle. Is this an acceptable way to obtain the pressure? I just find it easier. Is it accurate?


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## NomadicMedic (Feb 7, 2013)

Nope. The only two acceptable methods are palpation (for a quick baseline) and listening for the Korotkoff sounds. 

Keep practicing. It gets easier.


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## WTEngel (Feb 7, 2013)

^ What he said...


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## DesertMedic66 (Feb 7, 2013)

The bouncing needle can be caused by any slight movement the patient does, even movements that you can't see. 

The only ways are listed above


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## sra (Feb 7, 2013)

I can usually hear it well on average adults, but u have a very hard time hearing anything on person with larger arms. Any suggestions?


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## Household6 (Feb 7, 2013)

sra said:


> I can usually hear it well on average adults, but u have a very hard time hearing anything on person with larger arms. Any suggestions?



Have you tried using a larger sized cuff for those larger people? Are different sizes available to you?

Do you have a spyg and a steth you can take home and practice on your family members with? When I started, I would take everyone's blood pressure at home. I might have even tried to use my cuff on my dog once or twice..


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## Veneficus (Feb 7, 2013)

sra said:


> I can usually hear it well on average adults, but u have a very hard time hearing anything on person with larger arms. Any suggestions?



make sure you put the bell of your steth on the artery you are using, not just in the area.

This is accomplished by first finding the pulse. You may have to push muscle or fat aside to do it. Don't be afraid to manipulate the patient. It doesn't hurt.


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## sra (Feb 7, 2013)

I have been practicing at home. In fact its a family member that I can never hear anything on. Everyone knows that if they visit my house they are having their blood pressure checked. I'm going to try looking for the pulse first.


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## mycrofft (Feb 7, 2013)

Support the arm, have them turn the palm down and relax. The tendons etc slacken more that way so you're closer to the vessels.

How is your hearing?


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## mycrofft (Feb 7, 2013)

*I said,      HOW  IS YOUR HEEEEEEAR---ING!!!??*


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## bigbaldguy (Feb 7, 2013)

sra said:


> I have been practicing at home. In fact its a family member that I can never hear anything on. Everyone knows that if they visit my house they are having their blood pressure checked. I'm going to try looking for the pulse first.



Good for you practicing on family is a great idea. I used my dog as well 

You might also try not pressing too hard while listening. I know I have a tendency to press harder if I can't hear anything and this just makes it harder to hear as you put pressure on the artery.


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## Bullets (Feb 7, 2013)

also do not tuck the bell underneath the edge of the cuff, it make it harder to hear, even though everyone does it...


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## sra (Feb 7, 2013)

mycrofft said:


> *I said,      HOW  IS YOUR HEEEEEEAR---ING!!!??*



Lol. As far as I know my hearing is fine.

I never tried the palm down and holding the arm. Ill try that tonight.  I'm still trying to figure out how to hold the stethoscope, gauge, and pump without looking like a fool.


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## nwhitney (Feb 7, 2013)

sra said:


> Lol. As far as I know my hearing is fine.
> 
> I never tried the palm down and holding the arm. Ill try that tonight.  I'm still trying to figure out how to hold the stethoscope, gauge, and pump without looking like a fool.



I will hold their arm by placing their wrist in my right arm pit.  While facing the pt I place my forearm under their elbow and my right hand is free to inflate the cuff while my left hand holds the bell.  Also I am standing off to the right side of the pt.  I do this for two reasons: one it's easy for me to do what I need to do and two my pt's are seeing me because they are inebriated and may become unpredictable in their behavior.  If they become agitated then I already have some control and I'm off to the side which helps keep me out of their line of fire.  

Hopefully that makes sense, it does in my head.


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## sra (Feb 7, 2013)

That does make a lot of sense. I can't wait to try this technique. It will be a BP taking party at my house!


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## Veneficus (Feb 7, 2013)

sra said:


> That does make a lot of sense. I can't wait to try this technique. It will be a BP taking party at my house!



http://www.youtube.com/watch?v=VdO4fOAGzsM


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## Trashtruck (Feb 8, 2013)

sra said:


> That does make a lot of sense. I can't wait to try this technique. It will be a BP taking party at my house!



R.S.B.P, regrets only!


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## hogwiley (Feb 9, 2013)

I agree with the person who said if you cant hear anything, pushing the  bell further into the arm isnt likely to help any. I generally find just resting it over the brachial without pressure is the best way to go, as pushing down just seems to increase background noise as its hard to push down and keep the bell completely still.

Keep in mind some people are just damn hard to ascultate BP on. Its not always because you are doing something wrong. On these people sometimes it becomes necessary to either do it by palpation, or take extra measures to reduce or eliminate background noise or movement by the patient whenever possible.


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## Michael M (Feb 25, 2013)

Hi,

the only thing better than practice is ....more practice. Try different peoples armes and pulses.


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## StopNgo1000 (Mar 3, 2013)

just wait until you ride through the hood of a town, hitting bumps left and right and seeing the needle seize lol. It gets easier....just listen it takes some practice.


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## CPRinProgress (Mar 3, 2013)

It would be beneficial to invest in a nice stethoscope in my EMT class they had cheap ones but I bought a littman for $100 and I can hear perfectly


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## Handsome Robb (Mar 4, 2013)

CPRinProgress said:


> It would be beneficial to invest in a nice stethoscope in my EMT class they had cheap ones but I bought a littman for $100 and I can hear perfectly



I have a super nice scope as well. 

With that said, I'm a big proponent of learning to auscultate BPs and lung sounds with a cheaper scope. Then when you move to a better one it's that much easier and you also aren't stuck up poo creek without a paddle when you don't have your super-dooper-stethoscope.


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## Medic Tim (Mar 4, 2013)

CPRinProgress said:


> It would be beneficial to invest in a nice stethoscope in my EMT class they had cheap ones but I bought a littman for $100 and I can hear perfectly


Just because you can hear better doesn't me you know what you are hearing. Learning on a cheap one then switching to a nice one makes a big difference. I know EMTs that went out spending $200+ before they even went to class. They can use their own but when forced to use another they can't get the easiest of bps



Robb said:


> I have a super nice scope as well.
> 
> With that said, I'm a big proponent of learning to auscultate BPs and lung sounds with a cheaper scope. Then when you move to a better one it's that much easier and you also aren't stuck up poo creek without a paddle when you don't have your super-dooper-stethoscope.



Agreed


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