PPE, BP and pulse examination

Question 1

PPE

Answer 1

Hands washed before and after donning/doffing
Don 
1. Apron
2. Mask (eye protection)
3. Gloves

Doff

1. Gloves
2. Apron (eye protection)
3. Mask

Question 2

BP- introduction

Answer 2

Wash hands, don PPE- introduce yourself etc- been asked by doc to measure BP, involves inflating cuff round arm while listening to pulse w stethoscope- shouldn’t be painful but may be uncomfortable
If you would like me to stop at any time please just say
Have you got a preferred arm? Any pain? Please take your sleeve up/ adequate exposure

Question 3

BP- Patient position and cuff

Answer 3

Patient should be seated w arm comfortably placed around heart level
Appropriate cuff size important: fully deflated and confirm position of brachial artery (medial to bb tendon and lat to med epicondyle of humerus)- align marker to BA

Question 4

BP- Procedure

Answer 4

Approximate systolic BP by palpating radial pulse and inflate until you can’t feel it anymore
- 20-30mmHg above this, position diaphragm over RA
- listen for 1st Korotkoff sound, the first pulsatile sound (Systolic BP)
- deflate cuff slowly until you hear 5th Korotkoff sound (diastolic BP)
if abnormal redo, or use other arm- remove cuff and explain procedure complete, thank patient and explain ab follow ups, further investigations/treatments

Question 5

Pulses

Answer 5

Radial (rate and rhythm)- use index and middle finger, check for radio-radial delay (aortic dissection/ subclavian artery stenosis
Brachial in each arm- volume and character
Carotid- listen for bruits, then palpate (deep breath and hold)
Femoral if possible- radio-femoral delay or bruits
Popliteal (30 degrees, curl fingers into it- DONT PRETEND if impalpable)
Post tibial- both sides, compare this and dorsalis pedis in both feet