OSCEs Blood pressure by palpation and auscultation DONE

Question 1

Describe how you take the first estimate of blood pressure

Answer 1

• Introduce yourself, state why you are there, briefly explain what you will do, especially that the cuff will become tight around the arm and may be uncomfortable, but not painful. Explain that you will inflate the cuff twice.
• Gain the consent of the patient
• Check that the pressure guage is at 0 when the cuff is deflated
• The patient should sit with their arm supported, eg on a bench. The forearm should be at the level of the heart.
• Expose the upper arm. Thick or tight cloting must be fully removed, bot just rolled up.
• Find the tendons of the biceps by asking the patient to flex their arm. Use this to estimate the position of the brachial artery
• Place the arrow of the cuff on the brachial artery. Secure the cuff with about 3cm gap between the cuff and the elbow.
• Find the radial pulse with one hand, and inflate the cuff with the other.
• Inflate to 20-30mmHg above the point at which the pulse disappears
• Deflate the cuff slowly, and feel for the reappearence of the pulse - this is an estimation of the systolic pressure.
• Do not stop to ponder a doubtful reading or pump the cuff up again: deflate fully, repeat if necessary.

Question 2

Describe how you teke the second, accurate reading of blood pressure

Answer 2

• Fit the stethescope into your ears
• Find the brachial pulse by palpation (just medial to the biceps tendon)
• Place the head of the stethoscope over the pulse
• Quickly raise the pressure in the cuff to 20mmHG above the estimated systolic pressure. At this stage you should hear nothing.
• Reduce the pressure as before - be careful to go slowly especially around the diastolic pressure.