By H.Khorrami Ph.D.

http://khorrami1962.spaces.live.com http://scribd.com/khorrami4 khorrami4@yahoo.com

Sphygmomanometer & stethoscope

THE CONCEPT OF THE HYDRAULIC FILTER

SYSTOLE

COMPLIANT

DIASTOLE

RIGID

Blood pressures and the vascular system Arterial PressureVenous Pressure-

BP, methods
Palpation method Auscultatory

MEASURING BLOOD PRESSURE TURBULENT FLOW

1. 2. 3. 4.

Cuff pressure > systolic blood pressure--No sound. The first sound is heard at peak systolic pressure. Sounds are heard while cuff pressure < blood pressure. Sound disappears when cuff pressure < diastolic pressure.

Auscultatory method

Reynolds number
NR=*v*L/
: density of the blood L: characteristic dimension of the vessel, in this case diameter V: mean velocity of the blood : viscosity of blood <2300-------laminar flow >4000-------turbulent flow

Korotkoff sounds

Korotkoff Sounds First Phase

Second Phase Third Phase
The tapping sound followed by a murmur A loud crisp tapping sound

A clear tapping sound; onset of the sound for two consecutive beats is considered systolic

Fourth Phase Fifth Phase

Abrupt, distinct muffling of sound, gradually decreasing in intensity The disappearance of sound, is considered diastolic blood pressure- two points below the last sound heard


Blood pressures and the vascular system

MEAN ARTERIAL PRESSURE (MAP)

REMEMBER OHMS LAW?

CARDIAC OUTPUT

PERIPHERAL RESISTANCE

INSTANTANEOUS INCREASE

STEADY STATE INCREASE

Blood pressure
Normal values:

1 year 95/65

6 9 years 100/65

adults 110/65 - 140/90

PP & MAP

Classification of blood pressure for adults Category systolic, mmHg diastolic, mmHg

Hypotension
Normal Prehypertension Stage 1 Hypertension Stage 2 Hypertension Hypertensive Crisis

< 90
90 - 119 120 139 140 159 160 - 179 180

< 60
60 - 79 or 80 89 or 90 99 or 100 - 109 or 110

Steps for Measuring Blood Pressure

Seated for 5 minutes Patient Position Expose Upper arm Center of upper arm at heart level

Steps for measuring

Cuff applied 1 inch above crease at elbow Locate brachial artery Palpate radial pulse Inflate cuff until pulse disappears

Steps for measuring

Let air out Place stethoscope on brachial artery Pump up cuff to 20-30 above point of obliteration Let air out at 2 mmHg per second Repeat for the other hand Compare R & L BP

Steps for measuring

Note 1st and 5th Korotkoff sounds Chart:
#s Position Arm used Cuff size Normal, pre-hypertension, stage 1 hypertension, or stage 2 hypertension Recommendations of whats next

Orthostatic hypotension
BP in supine position BP on stand position Every 2min Decrease greater than 20/10

Effects of gravity on arterial and venous pressures. Each cm of distance produces a 0.77 mmHg change.

Veins Arteries

100 mm Hg

190 mm Hg Sphincters protect capillaries VENOUS PUMP keeps PV < 25 mm Hg

The Distribution of Blood

What would you tell a person about their blood pressure reading?
Definition of Blood Pressure Numerical Value Blood Pressure Category When to Recheck Medications if Necessary Lifestyle Modifications

Hyperemia
Definition:
Excessive accumulation of blood in a part of the body

Passive, by obstruction of the blood flow Active: relaxation of arteries Reactive, in response to an temporary interruption

Reactive hyperemia
1. Rise a hand, inflate up to 180mmhg
After 4min open the cuff

2. Inflate the cuff up to 70mmhg

After 4min open the cuff

3. Use a couple of cuffs for both hands

Rise a hand, inflate up to 180mmhg After 4min deflate down to 70mmhg and inflate the other hand up to 70mmhg

Following can cause sounds to be heard down to zero

Physiologic
a. Childhood b. Pregnancy c. Vigorous exercise

Pathologic
a. b. c. d. Hyperthyroidism Hyperactivity of adrenal Anemia Heavy pressure on the stethoscope

A cuff with a bladder too small for the patients arm will result in:
a. b. c. An inaccurately high reading An inaccurately low reading Sounds heard down to zero mmHg

Control of Cardiovascular Function Hormones

TPR
Total Peripheral Resistance = (Mean Arterial Pressure - Mean Venous Pressure) / Cardiac Output R = P/Q