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Old 04-12-2018, 09:12 PM
 
317 posts, read 147,036 times
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I am a home-health physical therapist and I have been checking BP several times a day on my patients for a few years.

I use a stethoscope and a manual cuff. However, I much prefer an automated cuff, provided it has been calibrated properly. The reason is, with a manual cuff you identify systolic and diastolic pressure by the sound made by blood flowing in your brachial artery (the artery in your forearm). Some folks have very hard-to-discern sounds; sometimes the environment is noisy due to traffic/TV/kids/pets, making it hard to identify exactly when the sound begins and when it stops. So there is a degree of subjectivity in the measurement.

An automated cuff relies on an oscillometer that detects vibrations in the wall of the arteries when blood flow is cut off and when it resumes. There is no subjectivity.

I also encourage my patients to check their BP regularly, with the same equipment. A trend, more so than the specific BP numbers, can be warning signs of a nascent problem.

And of course BP changes with position, anxiety, nervousness, physical activity... I find it funny (or rather, sad) that some folks don't believe it. We have much left to do in the realm of health literacy!

 
Old 04-12-2018, 10:34 PM
 
Location: Santa Monica, CA
14,431 posts, read 4,371,431 times
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I had an in home therapist come for a while after home from rehabs with messed up knee and she used a finger device...I wonder about that one. I know even talking will elevate BP. Even a couple CNA's in the rehabs used the finger BP monitor.
 
Old 04-12-2018, 10:36 PM
 
3,095 posts, read 1,036,929 times
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I'm always surprised that the medical assistants are so lazy or poorly trained with regards to the BP/HR measurement protocols.

1. They don't put the arm at the correct level. The arm needs to be at the level of the heart. If you're sitting in a chair, the assistant should either have you put your arm on an adjacent table or cabinet such that the arm is at the correct elevation or hold it to their side, like on their hip, supporting it, so that you're not straining/flexing to keep your arm in position, as that will affect the reading.

2. They don't wait long enough! The patient should be seated and resting (no movement) for five minutes or so before the reading is taken. Otherwise the measurement is not "resting" and thus is bound to not be that informative nor can it be consistent.

3. They don't take BP in both arms. Always take both arms. A significant disparity in BP between arms is indicative of atherosclerosis somewhere on the high side and needs to be worked up.
 
Old 04-12-2018, 11:02 PM
 
Location: Georgia, USA
19,813 posts, read 24,301,925 times
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Quote:
Originally Posted by jaminhealth View Post
I had an in home therapist come for a while after home from rehabs with messed up knee and she used a finger device...I wonder about that one. I know even talking will elevate BP. Even a couple CNA's in the rehabs used the finger BP monitor.
The finger gizmo is called a pulse oximeter. It measures the oxygen in your blood (and gives your pulse rate), not your blood pressure. They are entirely different things.
 
Old 04-12-2018, 11:16 PM
 
Location: colorado springs, CO
3,265 posts, read 1,371,059 times
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I prefer both taking a patientís BP & having mine taken, with a manual cuff & stethoscope.

I guess Iím old fashioned that way; the automatic cuffs were for the techs & the aides. If they got an atypical result I would check it myself before letting them chart anything & never with the automatic.

I have had them tighten on me for so long & so hard that it was everything I could do to not scream in pain. There is no way that did not affect the reading.

I think they have a difficult time with both hypovolemic (decreased blood volume) patients & dehydrated patients.
 
Old 04-13-2018, 06:37 AM
 
Location: Surfside Beach, SC
1,391 posts, read 2,203,883 times
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Quote:
Originally Posted by suzy_q2010 View Post
The finger gizmo is called a pulse oximeter. It measures the oxygen in your blood (and gives your pulse rate), not your blood pressure. They are entirely different things.
Although not commonly seen, there are actually quite a few devices that measure your blood pressure on your finger.

The Best Finger Blood Pressure Monitor In The Market Today!
 
Old 04-13-2018, 06:54 AM
 
8,853 posts, read 7,963,484 times
Reputation: 5022
Quote:
Originally Posted by EmilyFoxSeaton View Post
No just getting tired of people going off topic. White coat hypertension has been debunked in various studies. The only reason it persists is that doctors use it when they need to downplay a poor result.

There is no way this could have been white coat hypertension because it was a large difference in a matter of minutes.
LOL OP..I agree with you. Once I went to doc and the nurse CLEARLY was having trouble reading the BP ..I was running about 160/100 at the time. She wrote down 120/80 (to get it overwith) doc came in and said BP looks good. I called bull**** and told him that is not my BP...he took it himself and found 160/100.
 
Old 04-13-2018, 06:58 AM
 
Location: Kalamalka Lake, B.C.
2,774 posts, read 3,538,871 times
Reputation: 3504
No one here has every heard of packing a FITZBIT/??

I've been a Level 3 First Aid as required on job sites. It includes spine board and is a level below Paramedic training. If you practice you can take your own blood pressure by being quiet and using your own fingers. On job sites I had an Omron wrist in case of multiple people being injured.

Depending on your age, or having a physical job, or having health issues, keeping on top of your blood pressure is a good idea.
 
Old 04-13-2018, 08:19 AM
 
2,982 posts, read 2,950,773 times
Reputation: 7054
Quote:
Originally Posted by EmilyFoxSeaton View Post
I often find the people who take my BP wrong. If I go to a minute clinic they are wrong, sometimes they even can't "find" it. I have a nurse at work and this nurse is a real nurse and he can't take my BP worth a darn. According to him I am ALL over the place. One time 150//90 one time 110/60. I have stopped going to him because he is so useless.

But typically my doctors office is ok -- usually consistent.

So the last 4 times I went to the doctor my BP came back high with a consistent creep up. I became a little concerned and when today's reading back high... 129/83 (I am normally 110/70) for the 4th time over a year... I mentioned it to my doctor. Tests show that I am heading into menopause so... that is when BP can start creeping up.

So my doctor takes the BP. 106/72. She took it a second time and it was 110/70. I trust my doctor so I am happy with that. She suggested that maybe I had just come up the stairs when I had it done the first time but.. no, EVERY time I have my BP done I have just come up the stairs and it had been a lot lower.

I just think that various providers don't know how to take it. How can I monitor it if I can't get an accurate read?

Frustrated.
Yes, many ancillary medical providers cannot take BP well. And the automatic machines are useless.

But taking BP yourself is very, very easy. Get an old fashioned self blow up cuff with a built in stethoscoped from the pharmacy - they're very cheap - and learn how to take your own BP. I'm sure there's a tutorial on youtube. It's very, very easy to do.
 
Old 04-13-2018, 08:22 AM
 
7,744 posts, read 8,065,710 times
Reputation: 23936
Quote:
Originally Posted by EmilyFoxSeaton View Post
I often find the people who take my BP wrong. If I go to a minute clinic they are wrong, sometimes they even can't "find" it. I have a nurse at work and this nurse is a real nurse and he can't take my BP worth a darn. According to him I am ALL over the place. One time 150//90 one time 110/60. I have stopped going to him because he is so useless.

But typically my doctors office is ok -- usually consistent.

So the last 4 times I went to the doctor my BP came back high with a consistent creep up. I became a little concerned and when today's reading back high... 129/83 (I am normally 110/70) for the 4th time over a year... I mentioned it to my doctor. Tests show that I am heading into menopause so... that is when BP can start creeping up.

So my doctor takes the BP. 106/72. She took it a second time and it was 110/70. I trust my doctor so I am happy with that. She suggested that maybe I had just come up the stairs when I had it done the first time but.. no, EVERY time I have my BP done I have just come up the stairs and it had been a lot lower.

I just think that various providers don't know how to take it. How can I monitor it if I can't get an accurate read?

Frustrated.

It is frustrating. My blood pressure is generally high normal. However, my resting blood pressure (systolic) has hit 90 or 91 before. I have usually found that if I increase minutes of exercise per day or week that it drops down into the eighties. My primary care physician has told me that he would be happier with me exercising than getting on a blood pressure medicine. Most of the time my resting blood pressure is between low 80's and high 80's. No medical treatment is recommended unless the resting blood pressure is 90 or greater consistently.

I have seen my blood pressure vary considerably during a medical visit. First, the MA takes it. Howevever, I have made her repeat the test and if I really don't like what I see I will have my doctor do it himself. (There are actually primary care doctors who can still take a blood pressure)

Family history is important. Its one thing if you have a bunch of family that have had heart attacks and strokes. If none ever had, it may not be as big a concern.

Like you, my doctor has an office upstairs. Except its two floors up. I make a point of always walking upstairs instead of using an elevator for the exercise. So, I can be a little winded at the very top. I also find I don't wait long to get in once upstairs.

In answer to your question about "accuracy" I would suggest you not pay too much attention to any one blood pressure. Its averages you ought to be concerned about. However, every pressure you have indicated is very normal. I wouldn't be too concerned.
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