Measuring Blood Pressure (OSCE)

Equipment

💉 Stethoscope

💉 Sphygmomanometer

Introduction

1. Greet the patient and introduce yourself
2. Confirm patient details 
3. Explain the procedure in a brief, patient friendly manner
4. Get patient consent
5. Ensure the patient is sat in a chair with their preferred arm in line with their heart (upper arm exposed)
6. Ensure the patient is not in any pain
7. Wash your hands when you are ready to begin ✋

Setting up

1. Take an appropriately sized and fully deflated cuff
2. Palpate the arm (medial to brachii tendon of the biceps and lateral to the medial epicondyle of the humerus) to identify the brachial artery’s location
3. Lining the marker on the cuff up with the brachial artery, wrap the cuff around the arm

Measuring the blood pressure

Determine the approximate systolic blood pressure:

1. Check the cuff’s valve is closed
2. Using your index and middle fingers, palpate the patient’s radial pulse on the wrist
3. Begin inflating the cuff until you can no longer feel this radial pulse, the reading on the sphygmomanometer is the approximate systolic pressure
4. Deflate the cuff by opening the valve

Determine the accurate systolic and diastolic blood pressure:

1. Close the cuff’s valve
2. Over the brachial artery, place the diaphragm of your stethoscope
3. Again, inflate the cuff, but this time to a measurement which is 20-30 mmHg above the approximate systolic blood pressure
4. Deflate the cuff by about 2-3 mmHg per second
5. Listen 👂 out for a ‘pulsatile’ noise using your stethoscope, these are known as Korotkoff sounds, and the blood pressure at the first of these tells you the accurate measurement of the systolic blood pressure
6. Continue to deflate the cuff, when the pulsatile sound stops, the final one gives you the accurate measurement of the diastolic blood pressure
7. If the patient’s blood pressure is not within the ‘normal’ range, repeat after a few minutes or try the other arm

Abnormal blood pressure

💉 Hypertension: ≥ 140/90 mmHg in patients under 80/ ≥ 150/90 in patients over 80

💉 Hypotension: < 90/60 mmHg

💉 Narrow pulse pressure: < 25 mmHg difference between systolic and diastolic pressure

        Causes: aortic stenosis, congestive heart failure, cardiac tamponade

💉 Wide pulse pressure: > 100 mmHg difference between systolic and diastolic pressure

        Causes: aortic regurgitation, aortic dissection

💉 Difference between arms: > 20 mmHg difference

        Causes: aortic dissection

To finish

1. Remove cuff
2. Tell the patient you have completed the procedure and any next steps required based off the results
3. Thank patient 
4. Wash hands ✋
5. Document the lowest record of the patient’s blood pressure you identified 💉

Summary:

1. Greet the patient and briefly explain the procedure 
2. Prepare by palpating the arm, and positioning the cuff
3. Determine the approximate systolic blood pressure
4. Determine the accurate systolic and diastolic pressure
5. Establish whether the patient's blood pressure is 'normal' or which abnormal category it fits into
6. Complete the procedure by thanking the patient and explaining the next steps