Blood pressure help

[Robert89]

Hi all,

I just started my EMT-B class recently, and we've been working on taking blood pressures.

I have a question about this. I am using a very sensitive stethescope, and I have been noticing that I hear two sounds when taking a BP. The first sound is a very quiet, ticking or clicking sound. The second sound (which comes later) is a much louder sound. The question is, which sound signifies the systolic BP? Should I measure the systolic when I start to hear the very soft ticking/clicking sound? Or when I start to hear the more pronounced sound?

Thanks for the help!
Robert

 

[Shishkabob]

Depends.


Put the bp cuff on, inflate and listen on the artery until you hear the sounds end. Inflate to a few mmHg beyond that.

Slowly release the air, listening intently. The first sound you hear is your systolic. Keep going until you either no linger hear a sound, or it changes in any form (lighter or deeper). That is your diastolic.

 

[18G]

The very first sound you hear when releasing pressure from the cuff is your systolic pressure. No matter how faint... record it as the systolic. This first sound indicates that blood is flowing in the artery and that the pressure in that artery is higher than that being exerted by the blood pressure cuff.

Also, always remember this tip as it will help when assessing blood pressure in certain patients... as a general rule, always allow the air out of the cuff slowly. If you let it out too fast you may end up with an inaccurate pressure. This is especially the case in patients with slow or irregular heart rates.

 

[HCEMS]

The ticking/clicking sound that you are referring to may actually be you slightly moving the stethoscope or the pt moving his/her arm which grinds along the diaphragm of the stethoscope. Best thing I can tell you is to keep practicing and train your ears and before you know it will be second nature. Good Luck!

 

[itsabetime]

Here are a few tips that I've learned over the past few months
-Look for the needle to start ticking, this means that the systolic bp noise is soon to come. Don't rely on the needle for the actually pressures.
- lock the patients arm out. This forces the brachial artery closer to the surface and against bone. This way you can here it better, it also makes it easier to palpate.
- practice

 

[Simusid]

Depends.

Put the bp cuff on, inflate and listen on the artery until you hear the sounds end. Inflate to a few mmHg beyond that.

Slowly release the air, listening intently. The first sound you hear is your systolic. Keep going until you either no linger hear a sound, or it changes in any form (lighter or deeper). That is your diastolic.

Ok I'm a bit confused by that last part. I was taught to keep going until it's inaudible and that is the diastolic. We did go over the fact that the sounds do change (Kortikov sounds?) But I was not taught to listen for any changes in sounds as an indicator of diastolic pressure.

Yesterday I took a BP on a guy with a systolic of 142 and I heard clear strong beats all the way down to 30 and that really made me question myself, but I took it twice and it was the same, so I marked it as 142/30.

So I've got two questions. First, can a "change in sound" indicate diastolic?
and second, suppose my reading above was correct. Physiologically what are the causes of such a low diastolic?

 

[Jersey]

Ok I'm a bit confused by that last part. I was taught to keep going until it's inaudible and that is the diastolic. We did go over the fact that the sounds do change (Kortikov sounds?) But I was not taught to listen for any changes in sounds as an indicator of diastolic pressure.

Yesterday I took a BP on a guy with a systolic of 142 and I heard clear strong beats all the way down to 30 and that really made me question myself, but I took it twice and it was the same, so I marked it as 142/30.

So I've got two questions. First, can a "change in sound" indicate diastolic?
and second, suppose my reading above was correct. Physiologically what are the causes of such a low diastolic?

Such a low diastolic pressure, if accurate, is definite cause for concern! Recall how the myocardium is oxygenated.

The coronary arteries "fill" during diastole and with such a low diastolic pressure, the critical oxygenation and filling threshold has a very good chance of not being met. What was the patient's chief complaint?

 

[Veneficus]

Aortic regurgitation can cause abnormally low Korotkoff sounds. potentially all the way down to 0.

Intra arterial pressure seldom falls below 30mmhg short of an arrest.

 

[Jersey]

Aortic regurgitation can cause abnormally low Korotkoff sounds. potentially all the way down to 0.

Intra arterial pressure seldom falls below 30mmhg short of an arrest.

The only people I've ever seen with diastolic that low have been people with severe failure, usually intubated with extremely impaired output. If the patient your describing was generally not sick, regurg is usually a pretty solid reason for low korotkoff sounds