How to perform paradoxical pulse (in Lamen's terms)?

[ARRR10]

I know that you would pewrform a paradoxical pulse on a patient you suspect would have cardiac tamponade. I've searched online and the book is not as clear when stating the method obtaining the paradoxical pulse. My understanding is that you go up 20 mmHG above the person's systolic BP and listen for the first sound that correlates to the patient's expiration (record number). Then you release the pressure of the cuff slowly (about 2 mm HG) until you can hear the sounds (Korotkoff) on inspiration and expiration. Afterwards you get the difference and then in determine whether the person is suspected of having cardiac tamponade (i.e. >10 = cardiac tamponade).

Did I explain it right?

[sirI, MSN, APRN, NP]

Good job with your interpretation, ARRR10

listen for the first sound that correlates to the patient's expiration (record number). Then you release the pressure of the cuff slowly (about 2 mm HG) until you can hear the sounds (Korotkoff) on inspiration and expiration.

Place pt. in semirecumbent.

Yes, listen for the 1st sound during expiration, record. Then, take note of the pt.s breathing pattern as the Korotkoff sounds will disappear during the inspiratory phase, especially during deep inhalation. They reappear during expiration. Then, as you release the cuff again, listen for the sounds during inspiration/expiration. Subtract this reading from the first one you obtained to measure the PP.

Any reading above 10 is considered abnl., but not necessarily a dx of tamponade (normally see >12 with tamponade). You must assess for other s/s as well: JVD, hypotension, diminished heart sounds (Beck Triad), dyspnea, chest pain - just to name a few.

Again, good job!!