♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists on the internet. ♪
- Hi, I'm Bob Schrupp, physical therapist.
- And I am Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet.
- Well, in our opinion, Bob.
- Okay, Brad.
Today, I was just gonna show you
how to take a manual blood pressure.
And a lot of times people don't have to do this anymore
because there's those electronic units.
- Right.
- And there's actually those ones,
those little wrist units.
- Right.
- But a lot of those are very inaccurate I have found.
- Or inconsistent.
- Inconsistent, right. - Mh-mmm (affirmative).
- So you, you really should know how to
take a manual one if you're in the medical field.
- Mh-mmm (affirmative).
- And I don't know if you could do it
if you're a lay person, maybe you could.
- Sure. Well, my dad used to before all that other stuff
about 30 years ago, 'cause his blood pressure.
- Okay. So you're gonna need a stethoscope.
And by the way, I didn't know this,
but on some of the stethoscopes
you can listen to on this side, which is the diaphragm,
and the other side, which is the bell;
not on this one, you can't.
- Right.
- This one has no bell on it.
And I think you're always gonna make sure
that's tightened up too.
And you wanna make sure you, you can actually hear with it.
Yep.
- Mm. That works. Yep. Fine.
- Yep. All right.
And then you got the blood pressure cuff itself,
and this has got the inflater,
the pump to inflate it.
- Yep.
- And it's also got the sphygmo- (stuttering)
the sphygmomanometer.
(Bob & Brad chuckle)
- Tells your pressure.
- Right. And on, we're gonna show this closer up later on,
so you can see exactly what we're looking for
when we put it on.
- Mm-hmm (affirmative).
- So you're gonna start off.
You're gonna have the patient come in,
and they're gonna uncross their legs.
Okay. And they're supposed to be relaxing
for three to five minutes.
That doesn't always happen, does it, Brad?
- Right.
- When a lot of times people get their blood pressure...
You want the arm at around heart level,
which we are, we're pretty close here.
You want to ask the patient usually which arm they prefer.
Some of them might have a shunt or a PICC line,
or you know, if they've had a mastectomy.
- Or a pacemaker.
- Yeah. You wanna avoid that arm.
- Right.
- Obviously. So you're gonna start off by,
you're gonna palpate the brachial artery.
That's the artery where you're taking the blood pressure on.
And the brachial artery, yeah,
if you look at the bicep and where it attaches right here,
the brachial artery is usually right here.
- Right.
- Just, just medial to it.
And you know, you can, and the whole idea is you're just
trying to find it 'cause that's where
you're gonna put your stethoscope.
- Mm-hmm (affirmative).
- All right. So yours is right there.
- Yep.
- All right.
So you're gonna take the blood pressure cuff,
and before I even put it on, I'm gonna go ahead and,
and tighten the inflate, or rotate the inflater.
What would you call that little knob?
- Clockwise the valve. Close the valve.
- Yeah, and go righty tighty, lefty loosey.
- Right.
- But righty, you're gonna tight it.
So that, tighten it up.
Now on most of these there's an arrow
that shows if it's the right arm,
and it has an arrow for the right arm.
If it's a left arm, there's an arrow for the left arm.
This one doesn't have that.
- Yeah.
- So it just kind of has a little gauge there
where you're supposed to put it.
But, so.
- Right there again, you'll see that.
- And you're gonna put it up fairly high.
There's a interesting,
there were interesting comments that were online
about this brand...
- Mm-hmm (affirmative).
- because it, it was said
that you were not supposed to take the stethoscope
and put it underneath the cuff.
- Right.
- It's supposed to be below it.
- Right.
- Although in some cuffs it's actually touched,
it's attached to the cuff.
- Yeah, hmm.
- So how do, so, and I always got accurate readings
you know, despite that fact.
- Right. - So.
I wanna make sure it's up high enough here.
- So we're going through this step by step by the book,
after you do a hundred of these...
- Right.
It just goes like that. (snapping)
- Now the cuff itself should be, you know,
you should be able to slip a couple fingers underneath it.
- Mm-hmm (affirmative).
- If it isn't, maybe the cuff is too small for the person.
- Sure.
- Or if you get a really small person
you might need a small cuff, a pediatric cuff.
- Right.
- So, you got the inflater, you got the gauge here.
And what we're gonna do is,
I'm gonna go through it without showing the gauge first.
And then we're gonna go through it showing the gauge.
- Right.
- So, and it, with a close up.
With these, the stethoscope, a lot of times the,
the earbuds actually point one way...
- Mm-hmm (affirmative).
- and they point forward, that's, they should be
pointing forward when you put 'em in your ears
- It'd fit more comfortably
to get a better seal from the noise.
- Right, so. I'm gonna go ahead and put this...
if I'm talking really loud, let me know.
(Bob and Brad laugh)
So, I'm gonna put this right on the brachial artery.
- Yep.
- Put it a little bit above.
- Now, I'm gonna step in here with this.
It's usually a clip on the back.
You can clip it here,
you can clip it on their clothing.
Sometimes I have the patient hold it
so I can see it, depend on how alert the patient is.
- Sure. So it's righty tighty.
I'm gonna inflate to about 200 millimeters,
180 to 200 millimeters of mercury.
- Yep.
- And I feel like I'm talking really loud.
- No, you're fine, bud.
- Okay.
And then, or you can go maybe 30, 40 millimeters above
what their highest reading has been,
if they know what it is.
- Sure.
- So I go up to the 200.
(bulb pumping)
Can I see it, Brad?
- Mm, sure.
(bulb pumping)
- And then, then I'm gonna take the knob
and I'm gonna twist it left, and slowly let it out
a couple millimeters a second at a time.
- Mm-hmm (affirmative).
- And at first I'm hearing nothing.
And then all of a sudden I hear a bump, bump, bump, bump.
And at that first spot where you hear that bump, bump, bump,
that's the systolic pressure, the high, the higher pressure.
And then it starts to fade.
And that's the diastolic pressure.
- Right. Now I just wanna say one thing.
A lot of times you'll see the needle bump, bump, bump too.
- Right.
- But this is not a visual, uh.
You don't get the numbers from the,
where the needle starts moving the bump bump.
It's the audible.
- Right, it's, it's the audible part of it. Exactly.
So why don't we cut away
and then we're gonna show the close up of it.
- [Camera Operator] Okay.
- [Bob] Go ahead.
(bulb pumping)
All right, this is the dial,
and you can see Brad's pumping it up.
Going up to about 220, and now he's gonna let it go,
and let it, you know, again, two to three centimeters,
or millimeters of mercury a minute...
A second, I'm sorry.
And he's letting it go.
Keep going.
And at one point here
you're gonna start to see it bump a little bit.
There, it's bumping right about there, about 130.
Well even worse there. Yep.
- [Brad] Yeah.
- [Bob] Little less than 120 now.
- [Brad] Look at that pulse, Bob.
- [Bob] Yep.
- [Brad] You're alive!
- [Bob] Yep. And then...
- [Brad] Yep. This is proof.
- [Bob] And then right around 85,
which is usually my low number,
that's where it stopped bumping. So.
- [Brad] But again, I could still see
a tiny little background 70 or so, but...
- [Bob] Right.
So that's why you're going by the sound.
You're gonna first when, when you first...
- [Brad] That's called audible, Bob.
- [Bob] Right. Auscultation.
That's what it's called. - [Brad] (chuckling) Oh, wow.
- [Bob] So we, when you first start to hear the,
the sound, that's the, the systolic.
And then when you, when it goes away, that's the diastolic.
- Sure.
- So that's the two numbers.
Well, you know, it's good to measure
on the same arm each time.
And normally the,
what normally is considered is 120 over 80.
Although we had a whole video on that too.
Didn't we, Brad?
- Right, right. Uh, yeah. So, some of the details on...
- All right. Thanks for watching.
- Oh, yeah.
- See you later.
(Bob and Brad chuckle)
Hi, I'm Blo-
(Bob chuckles)
- Blob?
(Bob and Brad laugh) - Start again. Sorry.