hi guys, I need help with a blood pressure location

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BateMan

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i know you put the stethoscope head on the brachial artery but i need a pinpoint location. Can you guys help me? where do you usually put it. I have a picture it has 1, 2 , 3 and 4 located. 3 is at the middle of the elbow crease.

BP.bmp


http://www4.picturepush.com/photo/a/13133172/1024/Anonymous/BP.bmp
 
Not sure if this is a test question. All I will say is if you palpate the artery first it is a lot easier to find the placement.
 
BateMan said:
i know you put the stethoscope head on the brachial artery[/url]
Click to expand...

You just answered your own question. Feel for the brachial artery. Put it there.
 
Upon the palpable brachial pulse distal to the cuff. That is the correct answer.
 
Medial aspect of the antecubital space generally, but it can vary somewhat. You can usually palpate a brachial pulse somewhere therebouts. Where you feel the pulse would be the best place to place the diaphragm.

If this is a test question, it seems like an odd one. Usually the best way to tell if someone knows how to check blood pressure is to, you know, watch them do it.
 
A good stethoscope will pick it up anywhere in the general location. To practice... pump the cuff up , just until you see the needle jumps, then find in with the scope.
 
It will not be in the same "X marks the spot" for everyone hence why you need to actively palpate for it. The very obese, the elderly with atrophied arms, the hypotensive patient, LVAD's, bilateral amputee etc.

Here is the trick step 1 get the cuff and scope you got in EMT class. Then take as many of class mates, relatives, patients the day you do clinical manual BP's as you possibly can. Let's make that number 100 BP's taken, then come back and mark it for us.


Stethoscope Head The bell-shaped head of a stethoscope is a low frequency transducer, while the flat, diaphragm-shaped head is designed to detect high frequency sounds. Therefore to optimize detection of the low-frequency Korotkoff sounds, the bell-shaped head of the stethoscope should be used to measure blood pressure (1). This is often neglected, and

Marino MD PhD FCCM, Paul L. (2012-01-12 00:00:00-08:00). The ICU Book (Kindle Locations 3444-3447). Lippincot (Wolters Kluwer Health). Kindle Edition.
 
Although technically correct, the bell is usually smaller, and more importantly, if you don't obtain a perfect seal you can't hear anything with it. Some of our scopes don't have one anyway. The diaphragm is usually more practical in the field.

Littman has this tech on all their diaphragms now that lets you "tune" them for low frequency by applying a liiiight amount of pressure only, but again, try that while bouncing down the road.
 
Ecgg said:
It will not be in the same "X marks the spot" for everyone hence why you need to actively palpate for it. The very obese, the elderly with atrophied arms, the hypotensive patient, LVAD's, bilateral amputee etc.

Here is the trick step 1 get the cuff and scope you got in EMT class. Then take as many of class mates, relatives, patients the day you do clinical manual BP's as you possibly can. Let's make that number 100 BP's taken, then come back and mark it for us.


Stethoscope Head The bell-shaped head of a stethoscope is a low frequency transducer, while the flat, diaphragm-shaped head is designed to detect high frequency sounds. Therefore to optimize detection of the low-frequency Korotkoff sounds, the bell-shaped head of the stethoscope should be used to measure blood pressure (1). This is often neglected, and

Marino MD PhD FCCM, Paul L. (2012-01-12 00:00:00-08:00). The ICU Book (Kindle Locations 3444-3447). Lippincot (Wolters Kluwer Health). Kindle Edition.
Click to expand...
not all stethoscopes have that , in the case yours does not, they say to press lightly.

I don't . Lol
 
Brandon Oto said:
Although technically correct, the bell is usually smaller, and more importantly, if you don't obtain a perfect seal you can't hear anything with it. Some of our scopes don't have one anyway. The diaphragm is usually more practical in the field.

Littman has this tech on all their diaphragms now that lets you "tune" them for low frequency by applying a liiiight amount of pressure only, but again, try that while bouncing down the road.
Click to expand...

This is the problem getting a tricked out Littmann with tunable diaphragm, if you are new at listening to sounds how do you know when you applied enough pressure for it to be a bell or light enough for it to be a diaphragm? If you never heard what those sounds are to begin with?
 
I can press firm or lightly, doesn't matter, can hear it either way. Before my master cardiology, I didn't know what it sounded like
 
when i want to place my scope on the brachial artery i find the brachial artery and place my scope directly on top of it.

but seriously, practice practice practice. especially on healthy people.
 
What I do is apply the BP cuff (not inflated yet), extend the elbow, palpate the area just medial to the distal biceps tendon, and feel for the artery between the medial side of the elbow joint and that tendon. It'll be there. Once I locate the artery, I then "follow" the artery just distal to the skinfold and then put the stethoscope centered right on that spot. Using a relatively light pressure (I have a Cardiology III), I then listen, inflate the cuff a bit, listening for Korotkoff sounds. Once I confirm good placement, I inflate and listen as I inflate for the sounds to disappear. Once they go, I inflate another 20 mmHg and begin listening for the BP.

I have found that I'm quite accurate using this method...
 
My problem is that every time I go to check the BP we hit a bumpy patch in the road making it really hard to listen to the pulse. Sometimes it gets bad enough that I have to close the valve and wait for a smooth patch of road (sometimes it takes longer for the road to smooth out than get the BP!)

I know I know, join the club and welcome to EMS right? :P
 
Jim37F said:
My problem is that every time I go to check the BP we hit a bumpy patch in the road making it really hard to listen to the pulse. Sometimes it gets bad enough that I have to close the valve and wait for a smooth patch of road (sometimes it takes longer for the road to smooth out than get the BP!)

I know I know, join the club and welcome to EMS right? :P
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Lift up the patient's arm and rest it on your knee as you auscultate the pressure. This dampens road noise significantly.
 
Also, do not slip the bell under the distal end of the cuff. I see new EMTs do this all the time and it actually makes it harder to hear the sounds.

I have a ADC 601, their version of the Master Cardiology, which has a smaller diaphragm that i can replace with a bell. Ever since doing a rotation through a cardiac floor, i saw the docs up there use the bell A LOT. I know love the bell on y scope.
 
Jim37F said:
My problem is that every time I go to check the BP we hit a bumpy patch in the road making it really hard to listen to the pulse. Sometimes it gets bad enough that I have to close the valve and wait for a smooth patch of road (sometimes it takes longer for the road to smooth out than get the BP!)

I know I know, join the club and welcome to EMS right? :P
Click to expand...
I only auscultate outside the ambulance or at a stand still, even with my master cardio I find it best to take it by auscultation on scene and either use the monitor or palpate enroute
 
chaz90 said:
Lift up the patient's arm and rest it on your knee as you auscultate the pressure. This dampens road noise significantly.
Click to expand...

I do this too. On top of that, I lift my heels off the floor to add a little more noise dampening. I just keep the ball of my feet on the floor for support. I have found that unless the road is really bad, I can usually hear the BP, even if the siren is going.
 
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