Measurement of blood pressure by auscultation through a stethoscope for Korotkoff sounds

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:

During first aid, a person complains of headache. Check his (her) blood pressure.

Equipment for the practical skill:

• protective medical gloves;
• sphygmomanometer with the correct cuff.
• stethoscope;
• wipes with antiseptic solution;
• patient care simulator or simulated patient.

The procedure for performing a practical skill

• Introduce yourself.
• Obtain informed consent to the procedure:
  • give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure;
  • explain what you are going to do;
  • ask the patient to consent to procedure.
• Specify that there are no factors that can affect the accuracy of the measurement (time elapsed since the last meal, strong tea, coffee, alcoholic beverages, smoking, physical activity, etc.).
• Prepare the stethoscope and sphygmomanometer with the correct cuff for use.
• Place the person in the correct position:
  • in the supine position, the hand lies freely on the bed, palm facing up.
  • in a sitting position: the patient's back is pressed against the back of the chair, the hand lies on the table freely, both legs rest freely on the floor.

• Turn the screw to the left and remove all air from the cuff, free the shoulder area from bulky clothing.
• Check the position of the pressure gauge pointer relative to the zero scale mark.
• Put the cuff on the patient's bare shoulder at the level of the heart: 4 intercostal space (when measured while sitting or the mid-axillary line when measuring lying), its lower edge is 2 cm above the elbow bend.

• Fasten the cuff, make sure the cuff is firmly attached to the shoulder surface, the person does not feel any discomfort.

• Place the manometer scale directly on the cuff over the projection of the brachial artery.

• Find with palpation on the elbow bend for the pulsation of the brachial artery and put the phonendoscope membrane to this place tightly, but without strong pressure.

• Close the valve on the cylinder with your other hand, turning it to the right, and inject air into the cuff under the control of the phonendoscope until the pressure in the cuff, according to the manometer readings, exceeds by 20-30-40 mm the level at which the Korotkoff tones disappeared.
• Open the cylinder valve to the left with your right hand and slowly release the air (at a rate of 2 mm Hg for 1 sec). At the same time, listen to the tones on the brachial artery with a phonendoscope and observe the readings on the manometer scale.

• When the first sounds (Korotkov's tones) appear above the brachial artery, "mark" on the scale and remember the numbers corresponding to the systolic pressure.
• Continuing to release air, note the value of the diastolic pressure, which corresponds to the weakening or complete disappearance of Korotkoff tones.
• Repeat the procedure for measuring blood pressure twice with an interval of 2-3 minutes. Do not remove the cuff between measurements, but let the air out of it completely.
• Record the smallest numbers.
• Inform the patient about the measurement result.
• Turn the screw to the left and remove all air from the cuff.

• Remove the cuff from the patient's shoulder.