BP

[neogirl]

Anyone else having trouble learning to do manual BP? I feel like I can't hear it and I can't coordinate everything.

I've already watched those amplified sound videos on Youtube and could pretty much get the BP on those.

[NICUismylife, ADN, BSN, RN]

I feel like you only do this in the skills lab to get checked off. For me, it is simply too annoying to find the brachial pulse due to either fat or muscle.

TL;DR: You don't need to palpate for brachial pulse first.

:shrugs: If you're not hearing the heartbeat, chances are it's because of improper positioning of the stethoscope, so it's fairly solid advice to suggest palpating the pulse to ensure proper placement. Do you need to do it every time? Nope, but not a bad idea if you're not hearing anything....

[akulahawkRN, ADN, RN, EMT-P]

I feel like you only do this in the skills lab to get checked off. For me, it is simply too annoying to find the brachial pulse due to either fat or muscle.

TL;DR: You don't need to palpate for brachial pulse first.

While most of the time you don't need to palpate the brachial pulse, it's a good habit to get into. Some patients will have their brachial artery shift a little bit away from the usual place if you allow their elbow to flex more than a few degrees. Yes, the vast majority of people's brachial arteries will be in the usual anatomic position. You will usually get results just by placing your stethoscope head by landmarks. However if you ALWAYS palpate the brachial pulse, you will KNOW exactly where to place the stethoscope head on that patient regardless of their individual anatomy. I usually start by palpating in the area just medial to the Biceps Brachii tendon, just superior to the crease/AC fossa. Usually you'll be rewarded with a very strong palpable pulse.

Sometimes you have to "look" around a little bit in order to feel that artery. Sometimes you have to fully extend that elbow so that the artery can be palpated easily.

One big reason why I palpate the artery is that if I cannot palpate that pulse, that patient's BP is too low. It doesn't matter what the "numbers" say, no radial and no brachial pulse means the BP is insufficient to properly perfuse tissue.

How long does it take to do this? Just about 2 seconds if you know where to palpate.

The other tips above are also extremely important. You need to have the earpiece pointed directly down your ears. You need to be certain that the "active" side of the stethoscope (those that have rotatable heads) is placed on the patient. If you're listening to the Bell or Pedi side and the other side is against the skin, well, you're listening to air and not your patient. Yes, I still inadvertently do that...

This is a skill that simply takes time to fully develop. I really started to learn how to do this skill (literally) 20 years ago. I'm still not as good as I'd like to be, but I am usually faster than most NIBP machines at taking a blood pressure!

[Kuriin, BSN, RN]

Unless you're an EMT/Paramedic (which I see you are), or work in a clinic that doesn't offer an automatic sphygmomanometer, it definitely for me takes a while to palpate the brachial pulse. Maybe it's just I don't do it enough so I always have to figure out where it is.

I just remember having to do it in our first skills assessment (learning vitals) and having to do it on a person with tons of muscle made it difficult for me to find his pulse, haha. If it doesn't take any extra time to find it for you guys, all the more power. *thumbs up*

[Cat365]

This may sound silly and basic, but when you put the earpieces in your ears, make sure they're pointing forward into your ears, not backward into your ears. It would seem logically like you'd point backward, but it's actually the opposite.

I was taught how to take manual blood pressure for the first time at my job (I'm a tech, nothing fancy). Several people showed me how, and for a while I couldn't understand why I couldn't hear the dang beats. Or the times I did hear them, it was veeery faint. It was so frustrating because I was doing everything else correctly, and I'd almost always have to grab a co-worker to help. Those several people didn't think to include the direction you put it on your ears!! I figured it out after trying online tutorials. I always get it now haha. You'd be surprised how big of a difference that makes.

glad someone else has done that.

[applesxoranges, BSN, RN]

Make sure you can feel a pulse first. Make sure you have a decent stethoscope that is in correctly. In all honesty, a decent stethoscope will help you hear the sounds so much better. Practice and practice.

To be honest, when I do manual BPs, I don't palpate the brachial pulse because most of the time I can find it if I need to. Sometimes I'll find it if the respiratory therapist is having a hard time with finding the radial pulse for ABGs.

[beckysue920]

I know this is weird, but sometimes if you clench your back teeth together you will be able to hear the beats better. Weird, I know! It especially helps for a faint beat or if there is noise going on around you. Oh, yes, have the ear pieces pointing forward, as suggested in previous posts.