AIIMS SPECIAL IMAGE BASED QUIZ -4

BLOOD PRESSURE

•       Pressure Of Blood Exerted On The Walls Of Artery When It Flows Through It.

1.       SBP –

   Highest Pressure Of Blood In An Artery During Ventricular Systole

2.      DBP –

    Lowest Pressure Of Blood In An Artery Just Before Ventricular  Systole (Or  At Ventricular Systole )

•       Normal Blood Pressure – 120/80 mmHg

•       Artery Assessed = Brachial, Popliteal, Posterior Tibial Artery

Pulse Pressure – Difference b/w Systolic BP & Diastolic BP

   PP = SBP – DBP

   Normal PP = 120-80 = 40 mmHg

   Ratio = SBP  : DBP :   PP

                120  :   80  :  40

                    3   :    2   :   1

Mean arterial blood pressure (MABP)

•       An Avg. BP in an Artery during 1 Cardiac Cycle

  MABP =  DBP + 1/3 (PP)

  MABP =  (2 x DBP) + SBP

                                 3

Normal MABP =  93.3 mmHg

ASSESSMENT OF BLOOD PRESSURE - 

•       1. Direct Method ( Invasive Method/ IBP ) –

     Intra Arterial Catheter and Transducers are used for

     Circulatory collapse,  Amputation.

•       2.  Indirect (Non Invasive) Method (NIBP) –

        By using SphygmoManometer

•       Stethoscope : Invented by Rene Laensec 1816 France.

•       Sphygmomanometer : by Samuel , 1888 Austria

•       Types of Sphygmomamometer –

Indirect Assessment of BP -

1. Auscultation (with Stethoscope)
2. Palpation ( with Radial Artery Only SBP)
3. Oscillatory ( Oscillation in Sphygmomanometer)

1. Auscultation -

•       Avoid Smoking 30 Minutes

•       Keep the Patient at Rest for 5 Minutes

•       Supine / Sitting Position –

•       Arm at Heart Level (Below – High , Above – Low)

•       Legs don’t Cross Over (If yes – High)

•       Apply Cuff 2.5 cm (1”) above the Antecubital Fossa

•       Inflate Bladder at +20 mmHg more at the point where  Palapation Cease.

•       Deflate the Bladder at 2-3 mmHg/ Second. At the Point where First Kortakoff Sound is Heard. It denotes SBP. (Thumping Sound)

•       At the point where 5^th kortakoff Sound (Silence) appears, It denotes DBP.

2. Palpatory Method-

•       At point where Radial Pulse reappears denotes Systolic Blood Pressure.

•       DBP Cannot be assessed by Palpation.

3. Oscillation Method –

•       The point where Oscillation starts in Vertical Column of Sphygmomanometer, denotes SBP and  where oscillation Cease denotes DBP.

•       Monitor the Sphygmomanometer at eye level.

Size of Bladder of Blood Pressure Cuff - 

•       Width – 40 % Upper Arm Circumference

•       Length – 80 - 100 %  of Upper Arm Circumference (Double the width)

	Width (Cm)	Lenth (Cm)
1. Newborn	3	6
2. Infant	5	15
3. Child	8	21
4. Adult Arm	13	30
5. Adult Thigh	20	42

Errors in BP Measurement -

1. Low BP –

1. Wide Cuff (More than 40 % of UAC)
2. Above Heart Level
3. Tight Cuff (Normal – 1 Finger can Be Inserted)
4. Quick Deflation

2. High BP –

1. Narrow Cuff
2. Arm Below Heart Level
3. Loose Cuff
4. Legs Cross Over
5. Slow Deflation

  

	SBP (mmHg)	DBP (mmHg)
NORMAL	120	80
PRE – HTN	120 – 139	80 – 89 (No Medical Manag.)
HTN – 1	140 – 159	90 – 99
HTN – 2	>160	>160
HYPOTENSION	<90	<60