Blood pressure measurement
Measurement of arterial (blood) pressure is classified as a very important diagnostic examination methods, skills that should be in every civilized man.
Violation of blood pressure can be a symptom of serious diseases, timely diagnosis of which is able to provide at the present level of development of medicine or cure patients or reliably stop the progression of the pathological process, to extend the life of the patient, to prevent serious disorder and disability.This makes it necessary to consider the blood pressure measuring method as a pre-medical procedure which is carried out when the need to be right at home.Therefore, in every family, where there are patients with essential hypertension or suffering from other disorders of blood pressure, it is advisable to have a device for measuring blood pressure and be able to use it.
Blood pressure measurement is performed by special devices - sphygmomanometers, most of which are rubber cuff (for the clamping of the arteries), a pump or cylinder (air pre
blood pressure measurement principle for this method is as follows.On the arm (between the shoulder and elbow joints) worn hollow rubber cuff, which pumped air to the disappearance of the pulse at the radial artery (defined by 2-3 cm above the wrist on the inside of the forearm), t. E. Until the moment when the pressurethe cuff is greater than the pressure in the brachial artery.With the gradual deflation of the cuff and listening at the same time the artery below the cuff the first appearance of tones indicates that the pressure in the cuff equal to the systolic (during contraction of the heart), the pressure in the brachial artery and blood during a heart contraction begins to flow through the compressed artery.In the future, a sharp weakening (or disappearance) of tones indicates that arteries become passable and during cardiac relaxation (diastole), t. E. The pressure in the cuff is equal to diastolic blood pressure in the artery.
The device consists of: a) fields of the rubber cuff width from 12 to 14 cm, which is inserted in the case of non-elastic material;sewn thereon or other fastening devices for fixing the cuff on the forearm;b) mercury or spring manometer with a scale up to 300 mm or above;c) of the charge air balloon.All three main parts connected by a common system using the rubber tubes of T-shaped plastic or metal tube.For discharging excess air around the balloon has a valve.Blood pressure is measured with the following rules.
1. The room should be warm enough.
2. The patient sits or lies on her back on a couch or bed and rest for 10-15 minutes.During the pressure measurement the patient should sit or lie down quietly not to talk and not to follow the progress of the measurement.It must be borne in mind that in a supine position on the blood pressure is usually 5-10 mm lower than the sitting.
3. From cuff carefully expel air residue;impose it firmly, but not pulling on the shoulder, so that the bottom edge of the cuff was a few centimeters above the elbow, and fastens with a buckle, Velcro or hooks;hand must be completely naked, turned palm up, which is located at the heart level;sleeve shirt, if it is not removed, must not put pressure on his hand;muscles should be relaxed.
4. By the ulnar fovea puts tight, but without pressure stethoscope - best dvuushny with rubber or PVC pipes.
5. Subject to a complete silence in the cylinder room ( "pear") gradually begin to pump air into the cuff, in which the pressure gauge registers.
6. Injection to produce until disappear arising ulnar artery tones or noise, and then raise the pressure in the cuff by 30 mm.
7. After that, the injection is stopped.Slowly open the small valve from the cylinder.At the same time the air is starting to come out.
8. Note the height of the mercury column in which you hear the first clear noise.At this point, the air pressure in the cuff gauge and becomes slightly less than the maximum pressure in the artery, resulting in a wave of blood is able to penetrate into the peripheral section of the vessel and cause the tone.
notes in the scale of the pressure gauge and the figure is taken as an indication of the maximum (systolic) pressure.
9. With a further reduction of air pressure in the cuff, typically after a phase of the tones in the artery and then popping noise tones again.These "final" tones gradually strengthened, becoming more and more sonorous, and then suddenly and dramatically weaken and quickly terminated.
minimum (diastolic) pressure corresponds to the time of the disappearance of tones.
10. By subtracting from the maximum pressure Minimum pressure figures obtained figures obtained value of pulse pressure amplitude (pulse pressure), which is an important criterion for assessing the cardiovascular system.
11. As a result of a mental excitement, and perhaps direct mechanical stimulation of neural network in the first measurement blood pressure blood vessels in most cases turns out to be slightly higher than the subsequent ones.Therefore necessarily repeated measurement without removing the cuff, from which the air is completely discharged, 1-2 times at intervals of several minutes and is taken as the lowest value of arterial pressure.
12. Often, blood pressure, measured separately for left and right hand, is not the same and different at 10.15, and in some cases, and 20 mm.Therefore produce a consistent measurement of blood pressure in both arms and calculating the average index.
significant quantitative differences (40-50 mm) in blood pressure in different hands are evidence of the serious pathological disorders and require immediate consultation with a general practitioner of the patient.
13. need to re-measurement of blood pressure.In patients with unstable blood pressure, it is desirable to measure it several times a day to catch sleep influence, food, rest and work.
14. Obtained when measuring blood pressure numbers is usually written as a fraction, where the numerator corresponds to the systolic pressure, and the denominator - diastolic.
• systolic (maximum) pressure;
• diastolic (minimum);
• pulse pressure.
blood pressure (AD) is the pressure exerted by blood on the walls of the arteries, and depends primarily on the strength of contractions of the heart (cardiac output) and the tone of the arterial wall.
Systolic pressure - the pressure during systole of the heart, when it reaches its maximum value during the cardiac cycle.Diastolic Pressure - Pressure at the end of diastole of the heart when it reaches a minimum value over the cardiac cycle (resting period).Systolic pressure represents the heart, the diastolic pressure - the state (value) of peripheral vascular tone.
difference between systolic and diastolic pressure is called pulse pressure.
Blood pressure is determined by the most auscultatory method proposed by NSKorotkov (from the Latin auscultatio -. «Listening").For this purpose, special devices - sphygmomanometers.Tonometer cuff consists of a hook and loop fastener, a rubber bulb and manometer (mercury or membrane).Recently, electronic gauges are widely distributed.
measurement is carried out in the patient supine or sitting after 10 to 15 minutes of rest.The magnitude of the blood pressure measured in millimeters of mercury.
1. Apply the cuff to the patient's bare shoulder at 2-3 cm above the elbow.Clothes should not squeeze the shoulder above the cuff.Fasten the cuff is necessary so that only one finger held between it and the shoulder.
2. Put the right hand of the patient in the unbent palm-up position, the muscles should be relaxed.If the patient is sitting, the better for the extension of the limb to ask him to put under his elbow brush clenched his free hand.
3. Connect a pressure gauge with cuff.Check the position of the pressure gauge with respect to the zero mark.
4. find a pulse on the brachial artery in the cubital fossa and put the stethoscope to this place.
5. Close the valve on the pear and inflate the cuff to the air.The air need to escalate until the cuff pressure by the pressure gauge will not exceed about 30 mm Hg.Art.the level at which ceases to be determined by the pulsation of the radial artery.
6. Open the valve and slowly, at a rate of no more than 20 mm Hg, release air from the cuff.Simultaneously stethoscope to listen to the tones of the brachial artery and monitor the parameters pressure gauge scale.
7. When the brachial artery on the first sounds (called Korotkoff) noted systolic pressure.
8. At the time of a sharp weakening or complete disappearance of tones on the brachial artery to note the value of the diastolic pressure.
9. These blood pressure measurements, rounded to 0 or 5, written as a fraction: the numerator - the systolic pressure, the denominator - the diastolic pressure.For example, 120/75 mm Hg.Art.In addition to digital blood pressure recording in a fraction, the measurement data are recorded at a temperature in the sheet in the form of a column, which is the upper limit of the systolic and the bottom - the diastolic pressure.
measure your blood pressure is generally 2-3 times at intervals of 1-2 minutes, while the air from the cuff should be released completely.
should be borne in mind that in some cases between systolic and diastolic pressure begins to weaken the intensity of tones, sometimes significantly.This moment can be mistaken for a very high diastolic pressure.If we continue to let the air out of the cuff, the tone volume will increase, and they would stop at the level of the true diastolic pressure.If the pressure in the cuff will be raised only to the level of "intermediate tones decay", you can make a mistake in determining the systolic pressure.To avoid errors in the measurement of blood pressure, the cuff pressure must be high enough to lift, with a "margin", and releasing the air to continue listening to the total pressure drop in the cuff to zero.
perhaps even one mistake. When pressed strongly phonendoscope on the area of the brachial artery tones in some patients listened to zero.In these cases, you should not put pressure on the stethoscope head area of the artery, and diastolic blood pressure should be noted but a sharp decrease in the intensity of colors.
Normal blood pressure ranges from 140/90 to 100/60 mm Hg.Art.With age, blood pressure increases slightly.Exercise, excitement cause elevation of blood pressure.There are also daily fluctuations - lower pressure in the morning, in the evening - is higher during sleep the lowest pressure.After receiving food systolic pressure increases.