2006 - 2007 EXPERIMENT 3 Page 1

EXPERIMENT 3

Blood Pressure

Introduction

In this laboratory, you will become familiar with auscultation (listening to the sounds of
the body) and the measurement of blood pressure. The exercises involve measuring
your blood pressure using a stethoscope, blood pressure cuff and sphygmomanometer.
You will also assess changes in peripheral circulation and the effects of cuff location.

The modern era of blood pressure measurement started with the introduction of the
mercury sphygmomanometer by Scipione Riva-Rocci (1863-1937) in 1896.

Learning Objectives

By the end of today's laboratory you will be able to:

 Use a sphygmomanometer and stethoscope to measure human arterial blood

pressure
 Determine systolic blood pressure using a sphygmomanometer and detection of
a peripheral pulse

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APPARATUS

1. PowerLab 4/20T [ML860]

2. Finger pulse transducer [MLT1010]
3. Stethoscope
4. Blood pressure cuff
5. Sphygmomanometer

Using a Stethoscope

This section is a brief introduction on the correct use of the stethoscope. Your tutor may
have demonstrated how to use the stethoscope for an exercise in a previous
experiment, in which case this should serve as a reminder. Figure 1 shows the
essentials.

Figure 1. The correct use of a stethoscope: note the angle of the connection to the endpiece; it
shows that the bell is currently selected.

A stethoscope is basically a hollow endpiece connected by hollow tubes to

earpieces. Most stethoscopes have an endpiece with a flat diaphragm and a concave
bell, only one of which is directly connected to the earpieces at any one time. The
endpiece can be turned 180° to change the working side. In most stethoscopes, the
connection bends away from the side of the endpiece that should be placed against the
skin. The bell is generally better than the diaphragm for these lab sessions because it
reduces room noise. (If you have the connection the wrong way around, you will hear
only room noise.) The earpieces should point slightly forward to match the direction of
the external auditory canal.

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Procedure

To perform this experiment correctly, you must be familiar with the use of the
stethoscope and sphygmomanometer.

The sphygmomanometer conveniently combines a cuff and bulb with a pressure

transducer.

1. Plug the pressure transducer into pod input 1 on the PowerLab.

2. Plug the Cardio Microphone into pod input 2.
3. Wrap the sphygmomanometer cuff around the upper arm just above the elbow.
4. Click Start.
5. Practice inflating the cuff to approximately 180 mmHg and slowly reducing the
pressure (1-2 mmHg per second) until you are confident that you can use the
sphygmomanometer correctly.
6. Click Stop.

Figure 2. The placement of the blood pressure cuff and bell of the stethoscope.

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Exercise 1 : Auscultation of Blood Pressure

In this exercise you will measure blood pressure in the traditional way, using a
stethoscope to listen for Korotkoff sounds.

Procedure
1. Inflate the cuff until the pressure reaches approximately 180 mmHg.
2. Slowly reduce the pressure in the cuff (approximately 1 to 2 mmHg per second)
while listening through the stethoscope for Korotkoff sounds.
3. The systolic pressure is the pressure at which sharp, tapping sounds are first
heard.
4. Continue slowly reducing cuff pressure (at 1 to 2 mmHg per second). The
diastolic pressure is defined as the pressure at which the sounds disappear.
5. Completely deflate the cuff once diastolic pressure is determined. Do not leave
the cuff partially inflated or leave it inflated for a long time.
6. For each subject, record four measurements of the blood pressure. Allow one to
two minutes between measurements for recovery.
7. Repeat the procedure using other students until you feel confident in measuring
blood pressure.

Figure 3. A graphical summary of the method used in Exercise 1.

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Exercise 2 : Blood Pressure and Cardio Microphone

In this exercise you will use the Cardio Microphone to record arterial sound while
recording blood pressure.

Procedure:
1. Leave the the blood pressure cuff in place around the upper portion of the
student's arm (either arm), between the elbow and the shoulder.
2. Place the Cardio Microphone over the brachial artery and under the blood
pressure cuff so that it is held in position by the cuff.
3. Click Start.
4. Inflate the cuff until the pressure reaches approximately 180 mmHg.
5. Slowly reduce the pressure in the cuff (approximately 1 to 2 mmHg per second).
Deflate the cuff completely once the pressure has gone below 50 mmHg.
6. Click Stop.
7. Repeat the procedure using other students. Remember to add a comment with
the subject's name for later identification. Allow one to two minutes between
procedures for recovery.

Analysis
1. Examine your recording. The Cardio Microphone channel displays the Korotkoff
sounds as spikes. These spikes can be used to determine systolic and diastolic
pressure.
2. Place the Waveform Cursor on the first spike following the reduction in cuff
pressure. This represents the systolic pressure.

Figure 4: The first cardiomicrophone spike in the train (left arrow) indicates Systole.Diastole
corresponds to the last spike in the train (right arrow).

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3. Click on this point to enter the pressure in the value panel and add the comment
"systolic pressure" to the data.
4. Drag the number from the value panel into the appropriate column of the table.
 5. Place the Waveform Cursor on the last spike in the series. This represents the
diastolic pressure.
6. Click on this point to enter the pressure in the value panel and add the comment
"diastolic pressure" to the data.

Note: In some subjects it is not possible to determine diastolic pressure using this
technique!

Exercise 3 : Blood Pressure and Pulse

You will observe the changes in finger pulse while measuring blood pressure, and see if
pulse measurement could replace the use of the stethoscope.

Procedure
1. Remove the Cardio Microphone plug from pod Input 2.
2. Connect the BNC plug of the finger pulse transducer to the BNC socket for Input
2.
3. Place the pressure pad of the finger pulse transducer against the distal segment
(the tip) of the middle finger of your hand (on the same arm as the blood
pressure cuff). Use the Velcro strap to attach it firmly - neither loose nor tight.
4. Relax, put your hands in your lap and sit as still as possible to minimize any
movement artifact.
5. Click Start, the recorded pulse should look something like this.
6. Add a comment with the subject's name.
7. Inflate the cuff until the pressure is just above 180 mmHg. Note that the pulse
signal disappears.
8. Slowly deflate the cuff at a rate of 1 to 2 mmHg per second.
9. Once the pressure has reached 50 mmHg, completely deflate the blood pressure
cuff.
10. Click Stop.

Analysis
1. Examine your recording. Place the Waveform Cursor on the the first finger pulse
seen as the cuff pressure was falling. This represents the return of bloodflow to
the forearm.
2. Click on this point to enter the pressure in the Value panel and add the comment
"systolic pressure" to the data.
3. Drag the number from the value panel into the appropriate column of the table.

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Study Question
1. What are some possible sources of error or variation in this technique of blood
pressure measurement?
 2. Comment on how the systolic pressure determined by auscultation and by pulse
detection compare for each of the subjects in your group. Define systolic and
diastolic.

3. From your results, do you think that pulse measurement can replace the
stethoscope in determining diastolic pressure?

4. Define high blood pressure. Discuss how high blood pressure could affect the
patients’ life.

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