Measurement of blood pressure (Korotkov method)

Authors: Rednenko VV, Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Robot-patient / Patient
• Sphygmomanometer with the correct cuff.
• Stethoscope
• Wipes with antiseptic solution
• Pen and paper (answer form).

Clinical situation:

You are a district general practitioner. Patient A., 57 years old, came to see you on an outpatient basis or you came on a call for a home visit. Complaints of severe headache in the occipital region, feeling short of breath, dizziness, flashing of flies before the eyes, palpitations, pain in the region of the heart. These symptoms developed on awakening today. It is known that headaches bother the patient for several years, he did not seek medical help. Smokes 15-20 cigarettes a day for over 30 years. Objectively. General condition of moderate severity. The patient is emotionally agitated. Sits on a chair or lies on a bed. Temperature 36.4 ° C. The skin is pale, facial flushing. There were no peripheral edema.

Indications

• The need for accurate blood pressure measurement

Contraindications

• Not

Possible complications

• No complications

Possible mistakes leading to a change in the accuracy of the result:

• Wrong position of the patient's arm.
• Using a cuff that does not correspond to the shoulder circumference when the arms are full (the rubber inflated part of the cuff should cover at least 80% of the arm circumference).
• Short time of patient adaptation to the conditions of the doctor's office.
• High rate of cuff pressure reduction.
• Lack of control of blood pressure asymmetry.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
  • Use at least two identifiers (e.g., name and date of birth)
  • Use active communication whenever possible and ask the patient to state his or her full name and date of birth. (e.g., "Can you tell me your name and date of birth?" not "Mr. Smith I want to take your blood pressure.")
•  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.

• Clarify patient complaints.
• 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 on the desktop)
• At the first visit, blood pressure is measured on both arms

Main stage:

• Perform hygienic asepsis of the skin of the hands
• Explain the procedure to the patient
• Position the patient in the correct position:
  • in the supine position in bed, the hand lies freely on the bed, palm facing up.
  • in a sitting position on a chair in a position comfortable for the patient: 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.
  • the middle of the balloon cuff should be above the brachial artery and at the level of the heart.
• 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 patient does not feel any discomfort.
• Place the manometer scale directly on the cuff over the projection of the brachial artery.
• Find palpation on the elbow bend for the pulsation of the brachial artery and apply the phonendoscope membrane with your left hand to this place tightly, but without strong pressure.
• Close the valve on the cylinder with your right 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 Korotkov 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.

Final stage:

• Turn the screw to the left and remove all air from the cuff.
• Remove the cuff from the patient's shoulder.
• Treat the membrane of the phonendoscope with an antiseptic solution.
• Tidy up the workplace (original condition).
• Document your result using the answer form (Outpatient Medical Record, Inpatient Medical Record and / or Temperature Sheet).