I'm sorry I wasn't sure if it's okay to post this on the many old threads regarding blood pressures...
It is the question of what should be the systolic BP the first sound or the first loudest sound but this time with the palpatory method. My patient has always had a weak pulse so I had to go by palpation...
I've always known that the first pulse you feel is the systolic. On my experience, the trend is always a strong pulse gradually becoming normal like those Korotkoff sounds. This was always the case that on many situations that I can't hear those sounds clearly I just palpate my systolic and diastolic. However today I encountered something new. The first few pulses were kind of weak then came a set of stronger pulses. Thinking of Korotkoff sounds wherein the first sound is the systolic irregardless of a stronger sound following it, I used the first weak pulse as my systolic. I got a BP of 130/60.
Moving on the problem, I settled with 130/60 which is a BP not quite different from my initial assessment. Considering my patient stable I went on the usual. Approximately 30 to 40 minutes later, my patient's BP dropped to 60/40 and he's the type who goes lethargic.
Now if I had used the first strong pulse, I will get 100/60 a BP that reflects a gradual hypotension for my patient. I am now tormented by the fact that maybe if I used the stronger pulse as my systolic, I could have prevented such a drop.
Basically my question is, what is the true systolic? I've read many resources saying that it's the first thumping sound but I'm not so sure anymore? Is the case of palpatory method different? Should I go with the first strongest pulse when palpating for BP?
I would really appreciate answers. I don't wish to make such a mistake again.
If I had someone who had a SBP so faint as to require palpation, I got a doppler. Didn't have to depend on the sensitivity of the person palpating- it was either there or not. :)
On my experience, the trend is always a strong pulse gradually becoming normal like those Korotkoff sounds. This was always the case that on many situations that I can't hear those sounds clearly I just palpate my systolic and diastolic.
How do you palate a diastolic bp?
It's much more accurate to auscultate the Korotkoff sounds. If you can't hear them well, try adjusting your BP cuff, palpating for the brachial artery, or using a more sensitive stethoscope.
xtxrn, ASN, RN
4,267 Posts
If I had someone who had a SBP so faint as to require palpation, I got a doppler. Didn't have to depend on the sensitivity of the person palpating- it was either there or not. :)