DOCSLIB.ORG

Avoiding Missteps in BP Measurement

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Avoiding Missteps in BP Measurement ONLINE EXCLUSIVE Darrell R. Over, MD, MSc, Avoiding missteps in BP FAAFP UAMS (South Central) Family Medicine Residency Program, measurement Pine Bluff, AR [email protected] Making sure a patient is seated properly is just one way The author reported no potential conflict of interest relevant to ensure an accurate measurement. But steering clear to this article. of certain methods of measurement in particular patient populations is also important. lood pressure (BP) measurement is adjusted prevalence of hypertension is estimat- an essential component of the physi- ed to be 34%, equivalent to 85.7 million adults.4 B cal examination. The information ❚ Defining hypertension. For the gen- gleaned through this simple but vitally im- eral population, the Eighth Joint National portant assessment provides a basis for criti- Committee on Prevention, Detection, Evalu- cal decisions about diagnosis, prognosis, and ation, and Treatment of High Blood Pres- therapy in a variety of health care settings. In sure (JNC-8) defines hypertension as a BP of the emergency department, it helps guide re- 140/90 mm Hg or higher in adults younger suscitation efforts; in the intensive care unit, than 60 and a BP of 150/90 mm Hg or higher it helps to identify the deteriorating patient in adults ages 60 or older. For patients with and guide vasopressor drug titration; in the comorbid hypertension and diabetes, JNC-8 ambulatory office setting, it helps to identify recommends pharmacologic treatment when hypertension and the need for antihyperten- BP is 140/90 mm Hg or higher, regardless of sive therapy. age.5 In the office setting, inaccurate BP mea- Accurate measurement of BP provides surement can have profound effects. An over- the rational basis for the management of hy- estimation by only 5 mm Hg would result in pertension, which in turn may decrease the an erroneous diagnosis and unnecessary risk for stroke, congestive heart failure, and treatment of hypertension for about 27 mil- other cardiovascular diseases. Several inves- lion patients—entailing medication costs, tigators6-8 have observed that differences in potential adverse effects, and psychologic interarm systolic BP are associated with an issues associated with this diagnosis. Con- increased risk for peripheral vascular disease, versely, underestimation by 5 mm Hg would stroke, and other cardiovascular problems. miss about 21 million patients who actually have hypertension.1 Multiple factors impact accuracy; some might surprise you Why accurate BP measurement A number of factors may influence the ac- matters so much curacy of BP measurement in the office; About 75 million adults in the United States these are generally classified as related to have high BP,2 which costs the nation $46 bil- the patient, the observer, the technique or lion annually in health care services, antihyper- procedure, or the equipment used. A recent tensive medications, and missed days of work.3 systematic review by Kallioinen et al9 empiri- Among US adults ages 20 or older, the age- cally evaluated 29 potential sources of inac- MDEDGE.COM/FAMILYMEDICINE VOL 69, NO 2 | MARCH 2020 | THE JOURNAL OF FAMILY PRACTICE E1 curacy in the measurement of adult resting dures can target and mitigate many of the BP. Among them were identified sources of error; accordingly, all Patient-related: Recent meal or alcohol clinical staff responsible for obtaining a pa- intake; recent caffeine or nicotine use; full tient’s BP measurement should be trained bladder distention; cold exposure; white- not only in the correct method for accurate coat effect. Given the simplicity of assess- measurement but also in the identification of ing for these influences, it is worthwhile for factors that may introduce errors. office staff to ask patients, prior to the -rec ❚ The American Heart Association ommended 3 to 5 minutes of rest before BP (AHA) recommends that BP be measured in measurement, if they were rushing to make both arms at the initial evaluation, with the their appointment, need to void their blad- higher measurement used for monitoring BP. der, or have consumed food or drink or used The AHA also recommends obtaining at least tobacco within the past 30 minutes. 2 readings at least 1 minute apart and averag- Observer-related: Hearing deficit; ter- ing them as the patient’s BP.10 Other research minal digit bias (ie, preference for rounding recommends using a fully automated sphygmo- BP reading to a specific end digit, eg, 0); mea- manometer to take multiple readings with the surement of diastolic BP at Korotkoff phase patient resting quietly alone in either the exam IV rather than phase V. room or the waiting room11 as an effective and Procedure-related: Patient’s body posi- efficient method for accurate BP averaging. The USPSTF, the tion (eg, standing vs supine; legs crossed at ❚ The 2 principal noninvasive methods UK’s National knee; unsupported back or arm; arm lower of BP measurement are the manual ausculta- Institute for than heart level); incorrect size or placement tory technique and the oscillatory technique. Health and of cuff; talking during measurement (the con- Because of its simplicity and relative degree Clinical tent of conversation may influence results); of accuracy (when correctly performed), the Excellence, and reliance on a single BP measurement. auscultatory measurement remains common and other Equipment-related: Device model bias; in everyday medical practice. Remarkably, it is groups endorse device calibration error. one of only a few techniques for clinical exam- ambulatory As reported by Kallioinen et al9, the mag- ination of patients that has remained relatively BP monitoring nitude of these potential errors ranges from unchanged since it was introduced by the Rus- as the optimal small to large in both the positive and nega- sian physician and scientist Nikolai Sergeevich method for BP tive direction for both systolic and diastolic Korotkoff in 1905.12 However, accurate perfor- measurement. BP, and several sources of error are potential- mance of the auscultatory method requires ly bidirectional. For example, talking during adequate training and experience. BP measurement may result in an increase In contrast, automated oscillometric BP in systolic BP of 4 to 19 mm Hg and in dia- measurement is easily performed and requires stolic BP of 5 to 14.3 mm Hg; measurement minimal training. However, it is important of diastolic BP at Korotkoff phase IV rather to note that any condition altering oscilla- than phase V significantly increases diastolic tion amplitude or regularity (eg, arterial wall BP by 12.5 mm Hg; and recent alcohol intake stiffness or cardiac arrhythmia) will produce can affect systolic BP by –23.6 to +24 mm Hg erroneous results, and the reading must be and diastolic BP by –14 to +16 mm Hg. Over- confirmed by auscultatory measurement.13, 14 all, the researchers found significant direc- tional effects for 27 of the 29 potential sources Auscultatory methods of error, ranging from a mean –24 mm Hg to of BP measurement +33 mm Hg error for estimating systolic BP The mainstay of clinical BP measurement and a mean –14 mm Hg to +23 mm Hg for es- has been auscultatory methods to detect the timating diastolic BP.9 Korotkoff sounds, using a stethoscope and either mercury, aneroid, or “hybrid” sphyg- momanometers. Traditionally, the mercury Careful adherence to guidelines device was the “gold standard,” but the wide- ensures accurate BP measurement spread ban of mercury in health care settings Adequate training and standardized proce- has now all but eliminated its use. E2 THE JOURNAL OF FAMILY PRACTICE | MARCH 2020 | VOL 69, NO 2 BP MEASUREMENT ❚ Aneroid gauge sphygmomanometers Oscillometric methods have a metallic spring and a metal membrane of BP measurement that flexes elastically to translate pressure The auscultatory methods of BP measure- signals from the cuff and operate a needle in ment are gradually being replaced by oscil- the gauge. Owing to their complexity, these lometric techniques that are better suited to devices require regular recalibration, since automated methods of measurement. When inaccurate results may occur anytime the oscillations of pressure in the gradually de- needle does not rest on 0 before use. flating bladder cuff are sensed and recorded, ❚ The newer hybrid sphygmomanome- the point of maximal oscillation corresponds ters have an electronic transducer in place of to the mean intra-arterial pressure.15 The os- a mercury column; BP measurement is per- cillations sensed are vibrations in the arterial formed in the same fashion as with a mercury wall that are detected and transduced to an device, using a stethoscope and auscultation electric signal, producing a digital readout, for the Korotkoff sounds. and correspond approximately to the systolic ❚ Variations in technique for BP mea- pressure and continue below the diastolic surement can result in significantly different pressure. The actual systolic and diastolic readings. In 2005, the AHA published recom- pressures are indirectly estimated accord- mendations for BP monitoring to increase ing to a proprietary, empirically derived al- the accuracy of in-clinic measurements.10 gorithm that differs from 1 manufacturer to Recommendations for accurate BP measure- another. In older patients ment include: ❚ Validated oscillometric techniques or those with Patient preparation. The patient should have been successfully used in ambulatory diabetes who be seated in a chair with his or her back sup- BP monitors, which record pressure at
Load more

Recommended publications
  • General Physical Examination Skills for Ahps
    General Physical Examination Techniques for the Rheumatology Clinic This manual has been developed as an overview of the general examination of the rheumatology patient. Certain details have been specifically omitted because they have no relevance when examining a stable out patient in the rheumatology clinic. Vital Signs 1. Heart rate 2. Blood pressure 3. Weight 1. Heart Rate There are two things you want to document when assessing heart rate: The actual rate and the rhythm. Rate: count pulse for at least 15 – 30 seconds (e.g., if you count the rate for 15 seconds, multiply this result by 4 to determine heart rate). The radial pulse is most commonly used to assess the heart rate. With the pads of your index and middle fingers, compress the radial artery until a pulsation is detected. Normal 60-100 bpm Bradycardia <60 bpm Tachycardia >100 bpm 2. Heart Rhythm The rhythm should be regular. A regularly irregular rhythm is one where the pulse is irregular but there is a pattern to the irregularity. For example every third beat is dropped. An irregularly irregular rhythm is one where the pulse is irregular and there is no pattern to the irregularity. The classic example of this is atrial fibrillation. 3. Blood Pressure Blood pressure should be measured in both arms, and should include an assessment of orthostatic change How to measure the Brachial Artery Blood Pressure: • Patient should be relaxed, in a supine or sitting position, with the arms positioned correctly(at, not above, the level of the heart) • Remember that measurements should be taken bilaterally • Choice of appropriate cuff size for the patient is important to accuracy of measured blood pressure.
    [Show full text]
  • Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY
    Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR Aging, Heart Disease and Its Management: Facts and Controversies, edited by Niloo M. Edwards, MD, Mathew S. Maurer, MD, and Rachel B. Wellner, MD, 2003 Peripheral Arterial Disease: Diagnosis and Treatment, edited by Jay D. Coffman, MD, and Robert T. Eberhardt, MD, 2003 Essentials ofBedside Cardiology: With a Complete Course in Heart Sounds and Munnurs on CD, Second Edition, by Jules Constant, MD, 2003 Primary Angioplasty in Acute Myocardial Infarction, edited by James E. Tcheng, MD,2002 Cardiogenic Shock: Diagnosis and Treatment, edited by David Hasdai, MD, Peter B. Berger, MD, Alexander Battler, MD, and David R. Holmes, Jr., MD, 2002 Management of Cardiac Arrhythmias, edited by Leonard I. Ganz, MD, 2002 Diabetes and Cardiovascular Disease, edited by Michael T. Johnstone and Aristidis Veves, MD, DSC, 2001 Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, edited by William B. White, MD, 2001 Vascular Disease and Injury: Preclinical Research, edited by Daniell. Simon, MD, and Campbell Rogers, MD 2001 Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease, edited by JoAnne Micale Foody, MD, 2001 Nitric Oxide and the Cardiovascular System, edited by Joseph Loscalzo, MD, phD and Joseph A. Vita, MD, 2000 Annotated Atlas of Electrocardiography: A Guide to Confident Interpretation, by Thomas M. Blake, MD, 1999 Platelet Glycoprotein lIb/IlIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff, MD, and Eric J. Topol, MD, 1999 Minimally Invasive Cardiac Surgery, edited by Mehmet C. Oz, MD and Daniel J. Goldstein, MD, 1999 Management ofAcute Coronary Syndromes, edited by Christopher P.
    [Show full text]
  • Blood Pressure (BP) Measurements in Adults
    Page 5 Blood Pressure (BP) Measurements in Adults Ramesh Khanna, MD Karl D. Nolph, MD Chair in Nephrology Professor of Medicine Director, Division of Nephrology University of Missouri-Columbia Uncontrolled high blood pressure is present in every 3rd person in the American community and is attributed to be a major risk factor for progression of chronic kidney disease, coronary artery disease, and stroke. Therefore, blood pressure recording is the most common measurements at home and by healthcare professionals in all of clinical medicine. It might come as a surprise that majority of recordings are done in a less than ideal circumstances and consequently performed inaccurately. BP measurements using mercury sphygmomanometer by a trained health care professional is the gold standard for clinical assessment of blood pressures. The appearance of the 1st Korotkoff sound signals the systolic blood pressure and the disappearance of the 5th sound denotes the diastolic blood pressure. The hypertension experts believe and have increasing evidence to suggest that this method frequently either over diagnose hypertension or fail to recognize masked hypertension (blood pressure that is normal in the physician’s office setting but high at other times including at home). The four commonly recognized reasons for this are: Avoidable inaccuracies in the methods, The inherent variability of blood pressure; and The tendency for blood pressure to increase in the presence of a health care professional (the so-called white coat effect). Failure to standardize blood pressure measurement dos and don’ts. It is believed and also to some extent evidence based that the health care providers including physicians often do not follow established guidelines for blood pressure measurement.
    [Show full text]
  • Blood Pressure Year 1 Year 2 Core Clinical/Year 3+
    Blood Pressure Year 1 Year 2 Core Clinical/Year 3+ Do Do • Patient at rest for 5 minutes • Measure postural BP and pulse in patients with a • Arm at heart level history suggestive of volume depletion or • Correct size cuff- bladder encircles 80% of arm syncope • Center of cuff aligns with brachial artery -Measure BP and pulse in supine position • Cuff wrapped snugly on bare arm with lower -Slowly have patient rise and stand (lie them down edge 2-3 cm above antecubital fossa promptly if symptoms of lightheadedness occur) • Palpate radial artery, inflate cuff to 70 mmHg, -Measure BP and pulse after 1 minute of standing then increase in 10 mmHg increments to 30 mmHg above point where radial pulse disappears. Know Deflate slowly until pulse returns; this is the • Normally when a person stands fluid shifts to approximate systolic pressure. lower extremities causing a compensatory rise in • Auscultate the Korotkoff sounds pulse by up to 10 bpm with BP dropping slightly -place bell lightly in antecubital fossa • Positive postural vital signs are defined as -inflate BP to 20-30mmHg above SBP as determined symptoms of lightheadedness and/or a drop in by palpation SBP of 20 mmHg with standing -deflate cuff at rate 2mmHg/second while auscultating • Know variations in BP cuff sizes -first faint tapping (Phase I Korotkoff) = SBP; • A lack of rise in pulse in a patient with an Disappearance of sound (Phase V Korotkoff)=DBP orthostatic drop in pressure is a clue that the Know cause is neurologic or related or related to -Korotkoff sounds are lower pitch, better heard by bell medications (eg.
    [Show full text]
  • Does This Patient Have Aortic Regurgitation?
    THE RATIONAL CLINICAL EXAMINATION Does This Patient Have Aortic Regurgitation? Niteesh K. Choudhry, MD Objective To review evidence as to the precision and accuracy of clinical examina- Edward E. Etchells, MD, MSc tion for aortic regurgitation (AR). Methods We conducted a structured MEDLINE search of English-language articles CLINICAL SCENARIO (January 1966-July 1997), manually reviewed all reference lists of potentially relevant You are asked to see a 59-year-old articles, and contacted authors of relevant studies for additional information. Each study woman with liver cirrhosis who will be (n = 16) was independently reviewed by both authors and graded for methodological undergoing sclerotherapy for esopha- quality. geal varices. When she was examined by Results Most studies assessed cardiologists as examiners. Cardiologists’ precision for her primary care physician, she had a detecting diastolic murmurs was moderate using audiotapes (k = 0.51) and was good pulse pressure of 70 mm Hg. The pri- in the clinical setting (simple agreement, 94%). The most useful finding for ruling in mary care physician is concerned about AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8- the possibility of aortic regurgitation 32.0 [95% confidence interval {CI}, 2.8-32 to 16-63] for detecting mild or greater AR (AR) and asks you whether endocardi- and 4.0-8.3 [95% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 tis prophylaxis is necessary for sclero- grade A studies). The most useful finding for ruling out AR is the absence of early di- astolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to 0.2-0.4) for mild or greater therapy.
    [Show full text]
  • A Review of Pericardial Diseases: Clinical, ECG and Hemodynamic Features and Management
    REVIEW SHAM IK AIKAT, MD SASAN GHAFFARI, MD Department of Cardiology, Cleveland Clinic Department of Cardiology, Cleveland Clinic A review of pericardial diseases: Clinical, ECG and hemodynamic features and management ABSTRACT ECAUSE PERICARDIAL DISEASES are com- mon and often misdiagnosed, physi- Pericardial diseases are common, have multiple causes, and cians need to he familiar with their presenta- are often misdiagnosed. Physicians need to recognize the tions and distinguishing features. characteristic and distinguishing features of the three most This article reviews the clinical features, important pericardial conditions: acute pericarditis, cardiac diagnosis, and management of acute pericardi- tamponade, and constrictive pericarditis. In these tis, cardiac tamponade, and constrictive peri- conditions, proper diagnosis and appropriate management carditis. can significantly reduce morbidity and mortality. • THE PERICARDIUM KEY POINTS The pericardium envelopes the heart, extend- ing on to the adventitia of the great vessels. It Acute pericarditis is an important part of the differential is 1 to 2 mm thick and consists of an outer and diagnosis of chest pain syndromes and needs to be an inner layer. The tough, fibrous outer layer is distinguished from acute myocardial infarction both called the parietal pericardium, and the serous clinically and electrocardiographically. inner layer is called the visceral pericardium. The parietal and visceral pericardium are sep- Suspect pericardial tamponade in any patient with acute arated by fluid: 15 to 50 mL of an ultrafiltrate dyspnea, especially in the presence of a pericardial rub, of plasma that acts as a lubricant.1-2 elevated jugular venous pressure, and hypotension. The pericardium limits excessive cardiac movement and acute cardiac distension.
    [Show full text]
  • Simbaby™ Specs
    SimBaby™ Specs Normal & Difficult Airway • Airway opening acquired by head tilt, chin lift and jaw trust • Oropharyngeal and nasopharyngeal airways • Bag-Valve-Mask ventilation • Orotracheal and nasotracheal intubation • Sellick Maneuver • LMA insertion • Endotracheal tube insertion • Fiberoptic intubation • Gastric tube insertion • Variable lung compliance • Variable airway resistance • Tongue edema • Laryngospasm • Pharyngeal swelling • Decreased lung compliance • Right mainstem intubation • Gastric distention Pulmonary System • Spontaneous breathing with variable rate, depth and regularity • Bilateral and unilateral chest rise and fall • CO2 exhalation • Normal and abnormal breath sounds – bilateral • Lung Sounds: Normal, course crackles, fine crackles, stridor, wheezes and rhonchi • Oxygen saturation • See-saw respiration • Retractions • Pneumothorax • Unilateral chest movement • Unilateral breath sounds • Unilateral needle thoracentesis mid-clavicular • Unilateral chest tube insertion Cardiovascular System • Extensive ECG library with rate from 20-360 • CPR compressions generate palpable pulses, blood pressure waveform, and generate artifacts on ECG • Heart Sounds:Normal, systolic murmur, holosystolic murmur, diastolic murmur, continuous murmur and gallop • Blood pressure (BP) measured manually by auscultation of Korotkoff sounds • Pulses: Unilateral radial and brachial pulse and bilateral femoral pulses synchronized with ECG • Pulse strength variable with BP • Display of cardiac rhythms via 3-lead ECG monitoring • 12-lead dynamic
    [Show full text]
  • Blood Pressure Measurement Standardization Protocol
    Blood Pressure Measurement Standardization Protocol www. hearthighway.org 801-538-6141 We would like to extend a special Thank You to Dr. Roy Gandolfi for his help in editing this manual. This manual was funded in part by the Centers for Disease Control and Prevention through the Utah Heart Disease and Stroke Prevention Program, cooperative agreement number U50/CCU821337-05. The contents of this report are solely the responsibility of the authors and do not represent the opinions of the CDC Revised July 2006 Table of Contents 1. What is Blood Pressure? 2 2. Hypertension Overview 4 3. Non-Modifiable Risk Factors 5 4. Modifiable Risk Factors 6 5. Importance of Accuracy 8 6. Knowing the Equipment 9 7. Automated Blood Pressure Cuffs 11 8. Mercury Manometers 12 9. Pulse Obliteration Technique 13 10. Treatment and Referral for Adults 19 11. Treatment and Referral for Individuals over age 60 21 12. Treatment and Referral for Children 23 13. References 26 Appendices A: Following the DASH Diet B: Weigh In For Better Health C: Algorithm for Treatment of Hypertension D: Blood Pressure Levels by Gender, Age and Height Percentile E: CDC Growth Chart for Boys F: CDC Growth Chart for Girls G: Blood Pressure Management Quiz H: Blood Pressure Practicum 1 What is Blood Pressure? Key Abbreviations BP- Blood Pressure SBP- Systolic Blood Pressure DBP- Diastolic Blood Pressure JNC7- Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure CVD- Cardiovascular Disease BMI- Body Mass Index ABPM- Ambulatory Blood Pressure Monitoring ACE- Angiotensin-converting enzyme β-blockers- Beta-blockers LVH- Left Ventricular Hypertrophy Definitions Blood Pressure- measurement of the force exerted by blood against the walls of the arteries.
    [Show full text]
  • Physician Examination Procedures Manual
    Physician Examination Procedures Manual September 2011 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF PHYSICIAN EXAMINATION .......................................... 1-1 1.1 The Role of the Physician in NHANES .............................................. 1-1 1.2 Medical Policy Regarding the Examination ....................................... 1-2 1.2.1 Presence in MEC during MEC Examinations ..................... 1-2 1.2.2 Response to Medical Emergencies ...................................... 1-3 1.2.3 Maintenance of Emergency Equipment and Supplies ......... 1-3 1.3 Physician Examination ....................................................................... 1-3 1.4 Maintenance of Physician’s Examination Room ................................ 1-4 2 EQUIPMENT AND SUPPLIES ...................................................................... 2-1 2.1 Description of Equipment & Supplies ................................................ 2-1 2.2 Inventory ............................................................................................. 2-1 2.3 Blood Pressure .................................................................................... 2-1 2.3.1 Blood Pressure Equipment .................................................. 2-2 2.3.2 Blood Pressure Supplies ...................................................... 2-3 2.3.3 Description of Blood Pressure Equipment and Supplies .... 2-3 2.3.4 Blood Pressure Supplies – Description ............................... 2-5 2.3 HPV Supplies .....................................................................................
    [Show full text]
  • Bouncebacks Crit Care CHAPTER 11 – 63 Yo Man Fall
    BOUNCEBACKS! AVOID SERIOUS MISTAKES IN THE ED 31 Cases, 482 pages 10 Cases, 320 pages 28 Cases, 410 pages 30 Cases, 663 pages Praise for Bouncebacks! Bouncebacks! is a collection of cases that all emergency physicians dread, or should. - Academic Emergency Medicine, 2007 I would recommend this book for both residents and practicing physicians. For residency programs it can serve as an adjunct to case discussions and as a model for morbidity and mortality conference. For practicing emergency physicians it can provide excellent continuing education as an engaging and occasionally terrifying reminder of the high risk cases that masquerade as benign problems. - Annals of Emergency Medicine, 2007 Bouncebacks! Medical and Legal takes the reader along an enlightening educational journey beginning with deceptively well patient visits, followed by the feared patient “bouncebacks” with their unexpected bad outcomes, and ultimately revealing the courtroom proceedings that arose from the encounters… Bouncebacks! Medical and Legal should be mandatory reading for all involved in emergency medicine. - Annals of Emergency Medicine, 2012 Bouncebacks! Medical and Legal is an insightful and pragmatic analysis of emergency department malpractice litigation. The authors provide the reader with interpretive perspectives from all sides of patient care—the holistic view ultimately evaluated by a jury. The lessons presented are a good reminder for any practicing physician. - JAMA, 2012 After reading these 28 cases, I feel that I am less likely to miss similar patients in the ED. I highly recommend this as a book for anyone who cares for pediatric patients, and as a great teaching tool for residents and fellows. - The Journal of Emergency Medicine, 2016 The Bouncebacks! series is available from Anadem, Inc.
    [Show full text]
  • Text Illustrations in PPT Chapter 7. Blood Pressure and Sound
    Chapter 7. Blood Pressure and Sound Dr. Kurtuluş Erinç Akdoğan [email protected] • Blood-pressure values in the various chambers of the heart and in the peripheral vascular system help the physician determine the functional integrity of the cardiovascular system. • Fluctuations in pressure recorded over the frequency range of hearing are called sounds. The sources of heart sounds are the vibrations set up by the accelerations and decelerations of blood. • The function of the blood circulation is to transport oxygen and other nutrients to the tissues of the body and to carry metabolic waste products away from the cells. Blood pressure • Blood is pumped around the body by the heart. • It makes its way around the body through a network of tubes known as the vascular system. • Together with the heart they form the cardiovascular system. The vascular system • Three sub-systems: • Arteries: high-pressure arterial tubes which carry the blood away from the heart • Capillary network: fine, thin-walled tubes which allow transfer of nutrients & oxygen into cells and the removal of waste products from the cells • Veins: low-pressure tubes which return the blood to the heart 1. When the left ventricle contracts in response to the electric stimulation of the myocardium the left ventricle ejects blood through the aortic valve into the aorta. 2. The exchange of the nutrient material takes place at the capillary level. 3. The blood then returns to right atrium, then to the right 1 ventricle. 5 4. The blood is pumped from the 3 6 right ventricle into the pulmonary artery through the 4 pulmonary valve.
    [Show full text]
  • Blood Pressure Measurement
    Blood Pressure Measurement PhDr. Mária Sováriová Soósová, PhD. Training for Students 1. – 15. September 2019 UPJŠ, Košice, Slovakia Blood Pressure Blood pressure may be defined as the force of blood inside the blood vessels against the vessel walls. (Marieb and Hoehn, 2010 according to Dougherty, L., Lister, S., 2015) Blood pressure Systolic BP – is the peek pressure of the left ventricule contracting and blood entering the aorta, causing it to strech and there for in parts reflects the function of the left ventricule. Diastolic BP – is when the aortic valve closes, blod flows from the aorta into the smaller vessels and the aorta recoils back. This is when the aortic pressure is at its lowest and tends to reflect the resistance of the blood vessels. (Marieb and Hoehn, 2010 according to Dougherty, L., Lister, S., 2015) Factors influencing BP Age Gender Race Anxiety, fear, pain, emotional stress Medications Hemorrhage Increased intracranial pressure Hormones Diural rhythm Obesity Eating habits Exercise Smoking .......... Aerage and upper limits of blood pressure according to age in mmHg Age Average normal BP Upper limits of normal BP mm Hg mm Hg 1 year 95/65 undetermined 6 – 9 yrs. 100(105)/65 119/79 10 – 13 yrs. 110/65 124/84 14 – 17 yrs. 120/ (75)80 134/83 18 + yrs. 120/80 139/89 Classification of Hypertension ESC/ESH classification of office blood pressurea and definitions of hypertension gradeb (Williams, Mancia, Spiering, et al. 2018, p. 3030) Category Systolic (mmHg) Diastolic (mmHg) Optimal <120 and <80 Normal 120–129 and/or 80–84 High normal - prehypertension 130–139 and/or 85–89 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–109 Grade 3 hypertension ≥180 and/or ≥110 Isolated systolic hypertensionb ≥140 and <90 Methods of BP measuring Invasive - direct: direct in an artery continuous monitoring Noninvasive – indirect: Auscultation – Korotkoff sounds.
    [Show full text]