When taking blood pressure, is it the first beat or the loudest clearest sound that is the top number?

Question

Im an medical assistant extern and whenever I take the patients blood pressure and the professional MA or the office manager takes blood pressure, I get a wrong reading, like way off. Would someone give me some techniques about how to hear the systolic sound/taking blood pressure.

Answer 1

I usually inflate the cuff while feeling the brachial (or radial if I'm being naughty) until I cant feel the pulse anymore. I note that pressure then deflate the cuff. THen inflate it up again to 10mm Hg past that and listen with the stethoscope at the brachial.

The best way to describe what to listen for is when you first hear a sound then that is the systolic (the blood is able to squeeze it's way through the vessels). Only practice will be able to tell you what this sound is like, but I think it sounds like a whoosh.

The diastolic is when you stop hearing the wooshing sounds. Although sometimes these noises stop then start again at a lower pressure so you have to keep listening for a bit longer after the noises stop.

Hope this helps, but if all else fails then get you office to get some electronic BP readers as they don't contain mercury and are better for the person taking it as you can do other things while the machine does all the work.

Answer 2

The systolic sound is the first sound you hear. Usually the first beat is softer than accompanying beats.  When you are listening for the sounds make sure you are not rustling your steth tubes, or moving the diaphragm as you hold it down.  You may get inaccurate readings if you are pumping up the cuff way too high, or not enough too. If you think this might be the problem, you can palpate the BP by placing your fingers on the artery in the same place you would the diaphragm of the steth, pumping up the cuff, and feeling for the pulse to return...this will be fairly close to the systolic number, and almost always within 20 mm hg.  Wait a couple of minutes, reinflate the cuff, and only pump the pressure 20 mm hg higher than what you palpated.  Another common mistake is to not release the cuff slowly as you listen...try to do this as smoothly, evenly, & slowly as you can.

Hope this helps!