“So finally, Doc, you are getting around to something useful. Tell me how to take a blasted BP.”
Watch this, please:
Also, here is a video that reviews what you should hear when taking BP, although you have to crank the volume up considerably to hear the sounds in question.
Let’s talk about the gear you need to get this done, assuming you have time and funding to prep. You should be aware that using the BP cuff is not considered the gold standard of taking BP, but we will get into that in a later post. For the current purposes, it is as good as you are going to get.
First, a blood pressure cuff, with sphygmomanometer. Avoid the digital ones. They are (or can be) accurate, but Murphy’s Law dictates they will get wet, or the batteries will die, just when you need them most. And this blog is focused on grid-down scenarios, so we won’t get fancy here.
There are a bunch available on Amazon. Let’s talk about the price vs. value, and the need to have different sized cuffs to make things accurate, as mentioned in the video.
This one is the #1 best seller on Amazon, and the reviews indicate it either works or it doesn’t. If you get it and it works for you, good on you.
If you just want one, and you are willing to spend a bit more to get decent quality, this one is hard to beat, mostly as it is quite rugged. But the gauge is attached to the cuff; if you have folks of different sizes in your group, you will need an entire new $80 setup. This represents a significant downside for most resource-limited groups.
I like this one, and MDF has a reputation of solid quality without ridiculous price. Note the 3 year warranty. This is the one I have at home.
This one is a combo blood pressure cuff and stethoscope, both of very good quality, and a bit pricey.
Whichever you decide to buy, you will need blood pressure cuffs that actually fit the people you anticipate taking care of. As there is no way to know what is coming in the future, I’d recommend getting at least a big-boy cuff, and a kids cuff; this should cover all the bases. Note that the links I provided are to the MDF latex-free cuffs; the one you select may have different cuffs that will fit that particular model.
Now let’s talk stethoscopes. I have owned several: some very expensive Littmanns such as the Cardiology III and the electronic 3200 stethoscope. I have also put ears in the more expensive Master Cardiology and less expensive Littmann Lightweight II, as well as two different MDF models; which are the top-0f-the-line ProCardia and a less expensive Sprague-X model. I have not laid ears on MDF’s disposable Singularis DUET stethoscope; but if you have a group looking to stock up, it’s $80 for a box of 10, and they are likely sufficient to take BP and get a general feel for lung and heart sounds.
Littmann makes great stethoscopes; they are the most commonly purchased among physicians. Their fit and finish is good, likely better than MDF, but frankly they do not let you hear heart sounds any better. I carry an MDF ProCardia to work every day, and think the less expensive Lightweight II and Sprague-X models are perfectly fine. I would recommend purchasing one at at least those levels of quality (Lightweight II or Sprague-X) because you will use it for more than blood pressure.
I recommend against the electronic 3200 stethoscope because it (or at least mine) is optimally tuned to hear heart sounds–but lung sounds are all but inaudible. For me this was particularly awkward during my pulmonary fellowship. Should you be into cardiology, however, this is a great, albeit expensive, piece of kit. Also, I recommend against it, for the same reason I recommend against electronic BP monitors–Murphy’s law states the battery will always fail, right when you need it. And if it gets wet, you are plum out o’ luck.
Assignment #1: the obvious one: get yo’self the kit, and check blood pressures on both arms, on as many people as you can. Check your own blood pressure 4 times a day for a day or two; first thing in the morning and right before bed are important–it gives a feel for the natural variation in BP everyone has.
Bonus points for attempting to check manual blood pressures on the forearm or calf. The process is the same except you pick the correct cuff for the size of the forearm, and listen over the radial artery at the wrist. You can also put the proper sized cuff on the calf, and listen over the dorsalis pedis or posterior tibial artery. There are problems with these approaches, however, the BP found in the wrist is off +/- 5 mmHg from that found in the arm.
Both the wrist and ankle blood pressures are classically very difficult to hear. One tip is to start by inflating the cuff on the forearm/calf until you can no longer feel the pulse, which at least gives you some indication as to where to start.
Double special extra bonus points for using the information to calculate an ankle-brachial index, which is one of the commonly used methods to detect significant peripheral vascular disease. Should you detect an abnormality, I wouldn’t freak out, but would recommend having your primary care physician check that out; the gold standard ABIs are calculated using a different technique combining doppler ultrasound and pressure cuffs, so you may be off just due to technique.