BLOOD

PRESSURE
MONITORIN
G
WHAT IT IS ????

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 Blood pressure (BP) refers to the force exerted by circulating blood on
the walls of blood vessels. It is one of the essential vital sign.
Blood pressure is expressed in terms of two values:
Systolic Pressure: The pressure in the arteries when the heart
(specifically the left ventricle) contracts and pumps blood into the aorta.
Diastolic Pressure: The pressure in the arteries when the heart is at rest
between beats, refilling with blood.
BP reading is 120/80 mmHg

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Values ?????

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1. Elevated Blood Pressure:

o Systolic: 120-129 mmHg

o Diastolic: Less than 80 mmHg

2. Hypertension Stage 1:

o Systolic: 130-139 mmHg

o Diastolic: 80-89 mmHg

3. Hypertension Stage 2:

o Systolic: 140 mmHg or higher

o Diastolic: 90 mmHg or higher

4. Hypertensive Crisis (Emergency):

o Systolic: Higher than 180 mmHg

o Diastolic: Higher than 120 mmHg

o Immediate medical intervention is required.

5. Hypotension (Low Blood Pressure):

o Systolic: Below 90 mmHg

Diastolic: Below 60 mmHg 6

 Mechanisms Regulating Blood Pressure

Blood pressure is influenced by several physiological mechanisms:

1. Cardiac Output (CO): The amount of blood pumped by the heart in one minute. BP increases if CO
increases.

2. Peripheral Vascular Resistance (PVR): The resistance in the blood vessels that the heart must overcome to
pump blood. When blood vessels constrict (vasoconstriction), BP increases.

3. Blood Volume: Higher blood volume results in higher BP.

4. Hormones:

o Renin-Angiotensin-Aldosterone System (RAAS): Increases blood pressure by narrowing blood vessels

and retaining sodium and water.

o Antidiuretic Hormone (ADH): Promotes water retention, which raises BP.

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 Factors Affecting Blood Pressure

Several factors can cause variations in blood pressure:

 Age: BP generally increases with age due to reduced elasticity in blood vessels.
 Activity Level: Physical exertion raises BP temporarily, while rest lowers it.
 Stress: Emotional stress or anxiety can lead to increased BP.
 Medications: Drugs like beta-blockers, ACE inhibitors, and diuretics are used to manage BP.
Conversely, certain medications can elevate BP.
 Diet: High salt intake, alcohol consumption, and a lack of nutrients like potassium can affect BP
levels.
 Health Conditions: Conditions like heart disease, kidney disease, and endocrine disorders can alter
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blood pressure.
Sites for measuring blood
pressure

Upper arm – using brachial artery

Thigh- popliteal artery
Forearm – radial artery
Leg- posterior tibial or dorsalis pedis
A persistently high BP measured for greater than 3 times is
called hypertension and persistently lesscthan normal
range is called hypotension.

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 Equipment

Stethoscope
Sphygmomanometer with
appropriate size of cuff.
Digital, manual, aneroid are
different tyeps of
sphygmomanometers

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Importance of Blood Pressure Monitoring in
Emergency Medicine

In emergency care, blood pressure is a key indicator of:

 Shock: A life-threatening condition often marked by

low blood pressure.

 Hypertensive Crises: Rapid and severe elevation of

BP, leading to potential organ damage.

 Heart Attack or Stroke: Sudden changes in BP can

indicate cardiac or neurological events.
Trauma: Blood pressure monitoring is critical in assessing
internal bleeding and circulatory collapse.

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 Methods of Blood Pressure Monitoring

1. Manual Blood Pressure Measurement:

o Sphygmomanometer: This is the traditional tool used, which consists of a cuff, a rubber bulb to inflate the
cuff, and a gauge to measure pressure.
o Auscultation Method: A stethoscope is used to listen to blood flow sounds (Korotkoff sounds) as pressure is
released from the cuff.
2. Automatic Blood Pressure Monitoring:
o Digital Monitors: These devices automatically inflate the cuff and measure BP without the need for a
stethoscope. They use oscillometric methods to detect pressure changes.
o Ambulatory Blood Pressure Monitoring (ABPM): A portable device worn by the patient for 24-48 hours to
continuously record BP. This helps in diagnosing hypertension by tracking BP variations throughout the day.
3. Invasive Blood Pressure Monitoring:
o Used in critical care settings, a catheter is inserted into an artery (often the radial artery), allowing for
continuous and highly accurate blood pressure monitoring. 12
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 HOW TO CHECK ????

Preparation:

1. Position the Patient:

o The patient should be seated comfortably with their back

supported.

o Their arm should be resting on a table at heart level, with the

palm facing upward.

o The patient should be relaxed, avoid talking, and should have

been sitting still for about 5 minutes before the measurement.

o Avoid caffeine, smoking, or exercising for at least 30 minutes

before taking BP.

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1. Wrap the Cuff:
o Select the appropriate cuff size (the width of the cuff should cover
approximately 40% of the upper arm's circumference).
o Wrap the cuff snugly around the upper arm, about 1 inch (2.5
cm) above the elbow crease.
o Ensure that the cuff is at the same level as the heart.

2. Locate the Brachial Artery:

o Feel for the brachial artery pulse on the inner side of the elbow
(antecubital fossa).

• Place the stethoscope’s diaphragm over this artery (for the manual
method).

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 Steps for Measuring Blood Pressure (Manual
Method):

• 1. Inflate the Cuff:

 Close the air valve on the bulb of the sphygmomanometer by turning it
clockwise.
 Begin inflating the cuff by squeezing the bulb. Watch the pressure gauge as you
inflate.
 Inflate the cuff to around 20-30 mmHg above the normal systolic pressure
(around 160-180 mmHg if the patient's BP is unknown).
 If the pulse is very strong, you may inflate up to 200 mmHg to ensure it’s fully
compressed.
• 2. Gradually Deflate the Cuff:
 Open the air valve slowly (counterclockwise), allowing the pressure to fall at a
rate of 2-3 mmHg per second.
 Listen for the Korotkoff sounds through the stethoscope.
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• Record the Systolic Pressure:
 The first appearance of the sound (a tapping or thumping noise)
marks the systolic pressure. This is when the blood starts to
flow back into the artery as the cuff pressure decreases.
• 4. Record the Diastolic Pressure:
 Continue listening as you gradually deflate the cuff. The
diastolic pressure is recorded when the sounds disappear
completely. This marks the moment when blood flow is no
longer restricted by the cuff.
• 5. Completely Deflate the Cuff:
 After recording both the systolic and diastolic pressures, deflate
the cuff fully.

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Digital Blood Pressure Monitors:

If using a digital sphygmomanometer, the process is more automated:

1. Apply the cuff as instructed.

2. Press the start button, and the device will inflate the cuff automatically.

3. Wait for the monitor to display the systolic and diastolic readings along with the
pulse rate.
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Common Errors to Avoid:

 Cuff size: Using a cuff that is too small or too large will give inaccurate readings.
 Arm position: The arm should be at heart level. If the arm is lower, BP may appear
falsely elevated; if higher, it may appear lower.
 Patient movement or talking: The patient should remain still and quiet during the
measurement.
 Deflation rate: Releasing the air too quickly can result in inaccurate readings.
 Incorrect cuff placement: Ensure the cuff is wrapped properly and not too loose or tight.

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UNDERSTOODDDD

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Thank you
IT ALWAYS SEEMS IMPOSSIBLE
UNTIL ITS DONE