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Taking blood pressure in fat/obese patients.?
help. why is its easy to take the brachial pulse of thin people unlike when assesing those who have fat arms- I'm having a difficulty listening to their pulse and might include the korotkoff sounds using my stethoscope. If that happens, what should be done to hear it effectively. help.
another, the first time you place the stethoscope should you hear it right away? or some say when you've inflated it's the time you'll hear.
thanks.
One way is to drag yourself into the 21st century, and do it properly, like any engineer or scientist in any other field of endeavor does. That is, use a button microphone, attached to an inexpensive amplifier feeding into either a pair of headphones or small loudspeaker.
The microphone slips under the cuff exactly as your potty stethoscope does, and the results are superb.
It renders the whole Korotkoff charade superfluous, of course, because once you have the waveforms on-screen, they're so characteristic that the sounds are unnecessary, and Pd and Ps are recognizable instantly.
I put mine together with components which cost me in total about $15 from Radioshack.. It operates brilliantly, and also (if you want to be really scientific about it) you can insert the signal via a simple USB plug into your computer and see the waveform image on your PC screen.
There, you can capture it, print it out, -whatever. You can, -if you wish-, discuss them (both sounds and waveforms) with a colleague for second opinions if in doubt about some point, and of course, the chronological record is always there for reference on a later date.
The downside? ..... well, there is only one, really, but it's almost insurmountable for doctors. If you're not wearing your stethoscope you don't look nearly so lofty and important, sauntering down the hospital corridor with just a white coat and Staff badge ! The punters just think you're sort of,... well .... 'ordinary'. -Just like a policeman, without his helmet, or Batman, without his cape... They don't realize you're a God..
(But if it bothers you, you can just wear one anyway, - -"just in case" -like men's nipples! )