1 00:06:08,400 --> 00:06:11,520 Welcome back in this video, we are going to be taking a closer 2 00:06:11,520 --> 00:06:14,800 look into how to take the blood pressure 3 00:06:15,040 --> 00:06:18,000 using the mannequin. 4 00:06:18,000 --> 00:06:21,080 So before we think about taking the patient's blood pressure, 5 00:06:21,080 --> 00:06:23,600 it's important that we understand the equipment that we're using, 6 00:06:23,880 --> 00:06:26,440 so we're going to need to use a stethoscope. 7 00:06:27,600 --> 00:06:30,920 And we're also going to use a sphygmomanometer. 8 00:06:31,280 --> 00:06:34,040 That is a very long and fancy word for the blood pressure 9 00:06:34,040 --> 00:06:35,480 cuff, and the attached equipment. 10 00:06:35,480 --> 00:06:39,200 It is important to note that you use different equipment 11 00:06:39,200 --> 00:06:42,440 when you are doing the assessment on the mannequins, as then 12 00:06:42,480 --> 00:06:44,840 if you were doing it on a real human person 13 00:06:46,400 --> 00:06:47,960 in this particular piece of equipment. 14 00:06:47,960 --> 00:06:48,960 There is already a wire 15 00:06:48,960 --> 00:06:51,920 attached to the mannequin, so it's important that that is attached 16 00:06:52,280 --> 00:06:53,600 and that you must have that plugged 17 00:06:53,600 --> 00:06:56,000 in, otherwise you will not be able to get a reading. 18 00:06:56,000 --> 00:06:58,320 So when we're checking a patient's blood pressure, 19 00:06:58,760 --> 00:07:03,040 we are determining the pressure in the patient's arteries 20 00:07:03,320 --> 00:07:07,880 when the heart is contracted compared to when the patient's heart is at rest. 21 00:07:08,120 --> 00:07:11,000 So we should get to numbers at the end of our region. 22 00:07:11,440 --> 00:07:14,800 So the top number for the highest rate of pressure 23 00:07:15,120 --> 00:07:19,280 is called the systolic blood pressure and the bottom number, the bottom figure, 24 00:07:19,480 --> 00:07:22,200 is called the diastolic pressure, and the diastolic pressure 25 00:07:22,240 --> 00:07:24,520 refers to the blood pressure within the arteries 26 00:07:24,520 --> 00:07:26,880 when the heart is relaxed in between beats. 27 00:07:27,080 --> 00:07:30,840 So what we're going to do is going to attach the cuff to the patient. 28 00:07:30,840 --> 00:07:36,560 So in an adult patient, we would put the cuff around the bicep. 29 00:07:36,880 --> 00:07:40,920 There is a mark on your blood pressure cuff to indicate where the artery should 30 00:07:40,920 --> 00:07:44,240 be. So this artery should be lined up with their brachial artery, 31 00:07:44,480 --> 00:07:48,680 which is the artery that runs up the inner side of the arm and past the elbow. 32 00:07:50,560 --> 00:07:52,400 So we're going to attach this cuff 33 00:07:52,400 --> 00:07:54,840 around our patient or our mannequins are. 34 00:07:58,040 --> 00:07:59,600 And then we're going to be palpating 35 00:07:59,600 --> 00:08:02,360 which is another fancy word for feel. 36 00:08:02,800 --> 00:08:05,840 We're going to feel for our patients pulse, now in an adult, 37 00:08:06,160 --> 00:08:08,720 You would expect to feel it close. 38 00:08:09,080 --> 00:08:10,160 This is called ACF. 39 00:08:10,160 --> 00:08:12,080 This point of the body, you'd expect to feel it 40 00:08:12,080 --> 00:08:14,880 close to the inner elbow and you should be able to feel it. 41 00:08:16,080 --> 00:08:19,480 When you press gently with two fingers, however, it is a little bit 42 00:08:19,480 --> 00:08:22,960 more tricky in the mannequins because it's not exactly 43 00:08:22,960 --> 00:08:26,600 in the anatomical location that you might expect in a human . 44 00:08:26,600 --> 00:08:29,520 So in a mannequin in this particular model, at least 45 00:08:29,760 --> 00:08:33,400 the brachial artery is actually underneath the blood pressure cuff, 46 00:08:33,400 --> 00:08:36,640 so you wouldn't be able to feel it whilst the blood pressure cuff is on. 47 00:08:37,080 --> 00:08:39,920 So ordinarily, when we're checking someone's blood pressure, 48 00:08:40,080 --> 00:08:44,160 we would inflate the cuff and we would be palpitating the brachial artery. 49 00:08:44,520 --> 00:08:46,560 However, because we can't feel the patient's 50 00:08:46,560 --> 00:08:48,720 brachial artery, in this particular instance, 51 00:08:48,920 --> 00:08:52,440 we would have to use the radial artery, which is the one near the wrist. 52 00:08:52,720 --> 00:08:55,920 And that's OK, because that's reflective of what we have to do in practice anyway, 53 00:08:55,920 --> 00:08:56,920 because there are occasions 54 00:08:56,920 --> 00:09:00,960 where you might have to adapt your practice to meet the patient's needs. 55 00:09:01,240 --> 00:09:06,040 So for our particular patient, we're going to be feeling for the radial artery. 56 00:09:06,040 --> 00:09:11,280 OK, so once I can feel that artery and I can feel it beating. 57 00:09:11,280 --> 00:09:13,400 I would need to inflate my cuff. 58 00:09:18,400 --> 00:09:21,680 And when I can no longer feel 59 00:09:21,760 --> 00:09:23,680 the pulse anymore. 60 00:09:24,680 --> 00:09:27,680 That gives me an estimation. 61 00:09:27,800 --> 00:09:30,680 Of the patient's systolic blood pressure that does not tell me 62 00:09:30,680 --> 00:09:33,480 their exact systolic blood pressure, but it gives me an estimation. 63 00:09:33,840 --> 00:09:38,360 So that gives me a guideline of how much I need to pump this cuff up to. 64 00:09:38,800 --> 00:09:43,160 And the reason that we do that is so that we get a more accurate reading. 65 00:09:43,720 --> 00:09:49,400 It is possible if you went to a patient and you assume that most patients 66 00:09:49,400 --> 00:09:53,920 in the ideal world have a blood pressure of 120 over 80. 67 00:09:54,360 --> 00:09:58,320 It is possible for you to pump the cuff up to, say 130 68 00:09:58,880 --> 00:10:02,680 and listen and think that you hear the systolic blood pressure coming in 69 00:10:02,920 --> 00:10:03,440 when actually 70 00:10:03,440 --> 00:10:06,360 what you might be hearing is just a beat in between beats. 71 00:10:07,200 --> 00:10:11,000 So you could have instances where you don't pump the blood pressure cuff up enough. 72 00:10:12,120 --> 00:10:14,600 Also, it might be that you over inflate the cuff. 73 00:10:14,600 --> 00:10:18,080 So if you assume that people are not going to always be 120 over 80, 74 00:10:18,080 --> 00:10:21,880 you might think, OK, I'll pump everybody up to 170 180, to ensure 75 00:10:21,880 --> 00:10:24,040 that I catch people even with a high blood pressure 76 00:10:24,040 --> 00:10:26,720 that's causing unnecessary discomfort to all of our patients. 77 00:10:27,200 --> 00:10:30,920 So we inflate the cuff using this estimated 78 00:10:31,160 --> 00:10:34,560 systolic, which gives us a rough guide of how high to inflate it. 79 00:10:34,600 --> 00:10:38,320 So I felt the pulse disappear around 120. 80 00:10:38,320 --> 00:10:43,760 So I'm going to pump then to 20 millimeters of mercury higher than that. 81 00:10:43,760 --> 00:10:46,360 So I'm going to go up to 140. 82 00:10:46,360 --> 00:10:50,320 So this time I'm going to listen. 83 00:10:52,120 --> 00:10:54,880 So we're going to put my stethoscope in. 84 00:10:54,880 --> 00:10:56,840 And I'm going to position it 85 00:10:56,840 --> 00:11:01,120 around the ACF, now again, this is not entirely accurate 86 00:11:01,120 --> 00:11:03,360 anatomically compared to an ordinary patient 87 00:11:03,760 --> 00:11:06,560 because we have to position it where we know that the speakers are 88 00:11:06,800 --> 00:11:07,840 on our mannequin. 89 00:11:07,840 --> 00:11:09,120 So it's ever so slightly different 90 00:11:09,120 --> 00:11:11,120 and we are having to adjust our practice for that. 91 00:11:11,360 --> 00:11:15,160 But it's still very helpful and giving you that hands on experience 92 00:11:15,160 --> 00:11:18,360 of getting used to the equipment and understanding what you're listening for. 93 00:11:19,680 --> 00:11:20,560 So as I said, I'm going to 94 00:11:20,560 --> 00:11:23,440 pump up to 140 and then I'm going to be listening. 95 00:11:23,720 --> 00:11:27,040 And what I listen for is that first thud sound, 96 00:11:27,280 --> 00:11:31,200 which is the systolic number, I then keep listening and I'll be hearing 97 00:11:31,200 --> 00:11:35,000 thud, thud, thud which is the patient's heartbeat. 98 00:11:35,200 --> 00:11:36,640 And then when I can no longer hear 99 00:11:36,640 --> 00:11:40,120 it's anymore, I make a mental note of the final time that I heard it. 100 00:11:40,400 --> 00:11:42,440 And that's the diastolic blood pressure. 101 00:11:42,720 --> 00:11:45,800 So you should have two numbers in mind, and I'm going to have a go now 102 00:11:45,800 --> 00:11:48,040 and find out what we've got for this particular mannequin. 103 00:12:08,640 --> 00:12:11,680 When I heard that I did get 120, over 80, 104 00:12:11,680 --> 00:12:14,440 which is exactly what I would expect because 105 00:12:15,520 --> 00:12:17,640 I know that my patients blood pressure 106 00:12:17,640 --> 00:12:20,800 is set on the mannequin to be 120 over 80. 107 00:12:21,520 --> 00:12:24,640 Now the beauty of this is that as an educator, 108 00:12:24,880 --> 00:12:27,120 I can change the patient's blood pressure 109 00:12:27,360 --> 00:12:31,400 and then I can ask the students to assess the patient. 110 00:12:31,720 --> 00:12:34,160 And I know if you're getting the right blood pressure or not, 111 00:12:34,160 --> 00:12:36,440 because I know what that patient's blood pressure is. 112 00:12:37,320 --> 00:12:38,320 So it's very helpful 113 00:12:39,520 --> 00:12:40,680 because I wouldn't necessarily 114 00:12:40,680 --> 00:12:43,600 know what your colleagues blood pressure is if you were practicing on each other. 115 00:12:44,320 --> 00:12:49,120 So that is a whistle stop tour of how to assess your patient 116 00:12:49,120 --> 00:12:52,320 or your mannequins blood pressure using 117 00:12:52,320 --> 00:12:57,280 the sphygmomanometer with adjustments for the fact 118 00:12:57,280 --> 00:12:59,920 that we're doing it on a mannequin and not a real person. 119 00:13:00,320 --> 00:13:01,000 Thank you very much.