In patients with severe respiratory distress (eg., asthma) or pericardial tamponade, the pressure will vary significantly with the respiratory cycle (pulsus paradoxus). The digital pressure recording should not be trusted in the presence of an irregular rhythm. The varying RR intervals will often lead to inaccurate readings of both the blood pressure and the pulse. Digital devices essentially measure one systolic and one diastolic pressure and assume the rhythm is regular. By auscultation, one can better estimate the pressure. In patients with frequent premature beats and atrial fibrillation, the pressure varies from beat to beat. Accurate measurement of the blood pressure by this technique depends on the presence of a regular rhythm. Repeat the measurement until you get a clear reading during a period regular rhythm (if possible). If you hear an occasional sound at the beginning of step 6 above, it could be do to a variation of the pressure of a single beat which is common in the presence of an irregular heart beat. (2)The pressure may actually be higher than 200 and one could have inflated to the level of the ‘auscultatory gap’ which is a pressure range in some patients where the sounds may actually temporarily disappear which can cause significant underestimation of the systolic pressure. This is not recommended because (1) It may cause pain. This is the diastolic pressure.Īn alternate method is to arbitrarily pump the cuff to 200 mmHg and listen for the sounds. Drop the pressure slowly (2 mmHg per beat) until the sounds disappear. Listen for the onset of the Karotkoff sounds which is the systolic pressure.ħ. Inflating the cuff too rapidly to high pressures may cause discomfort and result in a temporary increase in the pressure over the baseline.Ħ. Inflate the cuff to a reading which is at least 15 mmHg above where the pulse was extinguished. Apply the stethoscope over the brachial artery above the elbow joint just below the cuff.ĥ. This estimates the systolic blood pressure.Ĥ. While palpating the radial pulse, inflate the cuff and note the pressure reading at the point the pulse is extinguished.

Apply the fully deflated cuff snugly around the upper arm and place the marked area over the inside (medial) aspect of the elbow which is over the brachial artery.ģ. The subject should be sitting in chair with his feet on the floor (sitting with the legs hanging off of the examination table will falsely raise the blood pressure).Ģ. You can find further information in most textbooks of Physical Diagnosis.ġ.

Below is a method that I use to measure blood pressure.

Sphygmomanometer korotkoff sounds