Assessing BP

emtmike11

emtmike11

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I am a student in the early part of my paramedic program, currently taking my emt-b course. I've learned to take BP and all the vital sign stuff and my question relates to Bp in particular. Before listening for the blood pressure, how important is it that I palpate the brachial artery? Does doing so help provide a more accurate reading? And, what if I can't feel the brachial artery? Thank you for any feedback.
 
Palpating the artery before auscultation doesn't really change any thing. It really only helps you locate the correct place to put the diaphragm.

Its totally acceptable to put the stethoscope on the arm where you believe the artery might be and do the BP that way. Just remember not everyone is going to be in the same spot.
 
^^he said it right. it is also pretty hard to palpate the artery on a large person. it is much easier to do it on a skinnier person.
 
Personally, I always palpate the brachial artery before I even apply the cuff. It's just one of my habits, everybody has one. Worse comes to worse and you have a bigger person you can put the cuff on the forearm and auscultate the radial artery just like the brachial artery. It's usually quiter though.
 
FWIW I make an effort to palpate for a brachial pulse. I'm not sure how much it helps me though. I do have a related question though. It seems to me that there probably is an ideal or "sweet" spot to place the scope head, right over the artery. I'm sure that most of the time I do not hit that spot (which is why I'm practicing). When trying to hear the diastolic I'm listening hard for the last faint beat to disappear.

It seems to me that if the head is off the sweet spot, I will incorrectly hear it disappear sooner and I will report/record and incorrectly high diastolic pressure (and potentially an incorrectly low systolic).

The head on my Littmann is about 1.5 inches. Suppose I'm shifted 1/2 or so, would you expect that to introduce a lot of error in the pressure?
 
Possibly. Of course you have to also ask if it's clinically relevant. Most blood pressure cuffs have a margin of error of +/-3, so a significant change has to be at least 6 mm/hg. I say 6 because a measured BP of 120 could in reality be 123 (+3) and a measured BP of 126 could also in reality be 123 (-3). While precision and accuracy is important, it also needs to be placed into context of the widder finding. A few mm/hg isn't going to change a borderline finding either way, little less a number firmly in the non-critical or critical criteria. Hence with any physical exam finding, history information, and tests, the information needs to be integrated when making a decision instead of looking at just a single point of data.
 
Mike,

You want to palpate the artery so that you can rack when it disappears, which allows you to have an idea of how high to pump up the blood pressure cuff. If you merely do it by sound, you might hit an auscultory gap and think you've passed the systolic, when really it's much much higher.

Additionally, being over the brachial pulse location is suposed to best conduct the pulse sounds. This is most beneficial on patients with BPs that are difficult to assess.

Remember to use the bell side of your stethoscope.
 
Linus, hit the nail on the head! it is best to find where to place the Steth. to listen.
 
dmawhorter said:
Linus, hit the nail on the head! it is best to find where to place the Steth. to listen.
Click to expand...

I would hope OP has learned how to take a BP by now. He has had over 4 years after all...
 
OP hasn't been active since June'10
 
I don't have a lot of experience, but I do know how to take a BP and have since 2010.

I'll throw in my 2 cents for whatever it's worth. I'm relatively lean and can actually see my skin slightly move up when my heart beats and blood perfuses the brachial artery. (Side note, how would I correctly say that, when the artery is in systolic pressure...? anyone?)

So I've been messing around with my arteries and feeling the carodic compared to various parts of my body to feel blood perfusion. (I can actually feel blood perfusing the proximal arteries just a tad quicker than the peripherial ones, kinda cool). Anyway, this may be obvious to some, but If you twist your wrist laterally and medially you will notice that the brachial artery actually moves just a bit. I always palpate for a brachial pulse and depending on how the patients arm is positioned (usually laterally but not always) I will palpate a little further up or down if that makes sense.. Just try it, rotate your wrist laterally and palpate for your brachial, move your arm medially with your fingers still over the brachial artery, you'll notice it moves and becomes weaker because your not right over it. Now again, I don't have a lot of experience, but I would guess that it makes a difference when auscultating and being able to hear whether your directly over the artery or just near it. It's a obvious significantly different pulse pressure when palpating..
 
Sorry to keep resuscitating this old post (pun intended), but did somebody say they use the bell side of the stethoscope to auscultate BP? I was never taught to do that, but is it actually better than using the diaphragm?
 
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