Vitals

• General inspection

• Heart rate

  • Radial artery

  • Count beats for 30 sec, multiply by 2

  • Report: Rate (N 60-100), rhythm, regularity, quality (3+ bounding/strong; 2+ brisk/normal; 1+ diminished/weak; 0 absent), symmetry

• Resp rate

  • Observe number of breaths for 30 sec, multiply by 2

  • Best done without telling patient

  • Normal = 12-20

• Temperature

• Blood pressure

  • Preparation

    • Seated (with back support, feet planted on ground) or supine

    • No recent smoking, caffeine, alcohol, exercise

    • Palpate brachial artery to confirm viable pulse

    • Select right cuff size

      • Width of cuff should be >40% circumference of patient’s upper arm

    • Position cuff ~2 cm above antecubital fossa

    • Position arm - slightly flexed, brachial artery at antecubital crease at heart level

  • By palpation

    • Palpate radial pulse

    • Inflate rapidly until radial pulse disappears

    • Reduce cuff at ~2 mm Hg per heartbeat

    • Report systolic BP - reappearance of radial pulse

  • By auscultation

    • Rest for one minute

    • Inflate cuff to 20-30 mm Hg above sBP determined by palpation (to avoid auscultatory gap)

    • Diaphragm over brachial artery.

    • Reduce cuff at ~2 mm Hg per heart beat

    • Report BP as SBP over DBP

      • SBP = appearance of sound

      • DBP = complete disappearance of sound

Rational Clinical Exam

• HTN / How to measure BP (1995)