Task Estimate systolic blood pressure by palpation. Measure systolic and diastolic blood pressure by auscultation Preparation – 4 marks Palpation – 2 marks Auscultation – 4 marks
Setting up Alcohol Gel Clean your hands Make it visible to the examiner Introduce yourself “Hello. Good morning. My name is YOUR NAME. I’m a first year medical student from University of Manchester” Confirm “May I please confirm your name?” “How would you like me to call you today?”
Setting up (cont’d) Informed Consent – explain what is involved EXPLAIN “Alright PATIENT NAME. I have been asked to check your blood pressure. This will involve me putting this cuff around your arm and inflating it” “This might feel a bit tight but it shouldn’t hurt” “I will inflate the cuff twice, or more if needed” “If at anytime you feel uncomfortable please let me know” CONSENT “Is that okay with you?” “Do you have a preference as to which arm I use? Check : IV lines / cannulas Female pt. ask for birth control implants
Preparation “ Could you please roll up your sleeves to about here” (show the patient how up you’d like them) “would you like any help with that?” Check Equipment Sphygmomanometer Cuff is fully deflated Dial is at zero Stethoscope Put the stethoscope on with the earpieces pointing forwards Gently tap the diaphragm and make sure you can hear a sound, if you can’t then turn the tap on
Preparation (Cont’d) Make sure the Sphygmomanometer is away from patient’s view Look for brachial artery Rest Pt. arm on the bench Ask them to bend their elbow Feel for the Biceps tendon Brachial artery medial to tendon Deflate the cuff and wrap it around pt. arm (according to the arrow)
Estimating Systolic BP To examiner: “ I will first get an estimate for the Pt. systolic blood pressure by palpating for their radial pulse” Find Pt. radial pulse Located lateral of forearm Inflate the cuff Up to 200mmHg Usually, up to this point the pulse is no longer palpable Deflate the cuff slowly To the point where the pulse becomes palpable again This is your estimated systolic blood pressure
Estimating Systolic BP Report: “The patient’s systolic blood pressure is ______ mmHg.
Systolic & Diastolic BP Make the sure the sphygmomanometer is at 0. Put the stethoscope on Place the diaphragm on patients brachial artery located on the upper arm medial to the humerus Inflate the cuff 30mmHg above your estimated systolic pressure value Deflate the cuff slowly First sound you hear = systolic pressure When this sound disappears = diastolic pressure
Systolic & Diastolic BP Report: “The patient’s systolic blood pressure is ______ mmHg and diastolic pressure is ______ mmHg, accurate up to 2 mmHg”
Task Should be able to locate and count any two of the following pulses: carotid temporal facial brachial radial ulnar posterior tibial dorsalis pedis Location and accurate measurement of each pulse – 4 marks
Carotid Pulse Image 1: How to feel for the pulse Image 2: Anatomy of carotid artery Located in the Neck medial to sternocleidomastoid muscle Carotid artery Feel for it on one side only!
Temporal Pulse Image 1: How to feel for the pulse Image 2: Anatomy of temporal artery Located on the temple bone Directly infront of the ear Superficial Temporal Artery Feel for it on one side only!
Facial Pulse Image 1: How to feel for the pulse Image 2: Anatomy of facial artery Located on the Mandible (lower jawbone) on a line with the corners of the mouth Facial artery Feel for it on one side only!
Brachial Pulse Image 1: How to feel for the pulse Image 2: Anatomy of brachial artery Located on upper arm Medial to humerus Brachial Artery
Radial Pulse Image 1: How to feel for the pulse Image 2: Anatomy of radial artery Located on the lateral of the wrist Radial Artery
Ulnar Pulse Image 1: How to feel for the pulse Image 2: Anatomy of ulnar artery Located on the medial of the wrist Ulnar Artery
Posterior Tibial Pulse Image 1: How to feel for the pulse Image 2: Anatomy of posterior tibial artery Located on the medial side of ankle 2cm inferior and 2cm posterior to the medial malleolus Posterior Tibial Artery
Dorsalis Pedis Pulse Image 1: How to feel for the pulse Image 2: Anatomy of dorsal pedis artery Located on the top of the foot Immediately lateral to the extensor hallucis longus Dorsal Pedis Artey