Blood pressure measurement

Introduction

• Wash hands
• Introduce self
• Ask Patient’s name, DOB and what they like to be called
• Explain procedure and obtain consent
• Ensure the patient has been seated for 5 minutes
• Ask them to try to relax and not speak or move during the measurement

Equipment

• Sphygmomanometer – identify the correct cuff size for the patient
• Stethoscope

Preparation 

• Expose the patient’s arm and remove tight-fitting clothing
• Apply the sphygmomanometer cuff
  • The bladder should encircle at least 80% of the arm circumference 
  • The bladder must be placed over the mid-upper arm
  • The artery arrow marker (or mid-point of the cuff bladder) should be placed above the brachial artery pulsation
• Ensure the patient is seated comfortably at rest with back supported and legs not crossed
• Support their forearm horizontally on a surface at the level of their heart

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Systolic blood pressure estimation

• Palpate their brachial pulse (above the antecubital fossa) with index and middle finger 
• While palpating the brachial pulse, inflate the blood pressure cuff until the pulse disappears
• Systolic blood pressure estimate = the sphygmomanometer pressure when the brachial artery pulsation can no longer be palpated 
• Deflate the sphygmomanometer cuff quickly by fully opening the valve

Measurement

• Palpate their brachial pulse (above the antecubital fossa) with index and middle finger to identify and remember the point of maximal pulsation
• Inflate the sphygmomanometer to 30mmHg above the systolic blood pressure estimate
• Place the diaphragm or bell of the stethoscope over the point of maximal pulsation of the brachial artery 
• Slowly deflate the sphygmomanometer cuff (2-3mmHg/s)
  • Systolic blood pressure = the sphygmomanometer pressure at which the first Korotkoff sound is heard (not when the sphygmomanometer dial starts to pulsate – ignore this)
  • Diastolic blood pressure = the sphygmomanometer pressure when the Korotkoff sounds disappear
• When the diastolic pressure has been identified, quickly deflate the sphygmomanometer cuff by fully opening the valve

To complete

• Remove the sphygmomanometer cuff
• Thank patient and ask them to get dressed
• Document procedure and result in patient’s notes

Test your knowledge

What are the definitions of hypertensive urgency and hypertensive emergency?

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In which patients would you consider secondary causes of hypertension?

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Which screening tests would you consider to investigate secondary hypertension? Note which condition each test screens for.

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Now try an OSCE station

1. Blood pressure skill
2. Find lots more stations here