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So we are going to take your blood pressure now. Is that okay, Duncan?

Yeah, that is absolutely fine.

Okay. So we have washed our hands using the correct technique and we have put gloves on. We know our equipment is clean because we cleaned it after the last patient, so we are going to take blood pressure.

Is there any particular arm you use?

We use the left arm. This is because of the configuration of the artery, the blood has an easier passage through the left arm. We use the bicep here picking up the pulse right here and this is at the same height as the heart.

Okay. What if I have got an injury to that arm?

If you have got an injury to that arm or if you have a fistula. Some renal patients have a fistula, some female patients have problems, if they have had a mastectomy with a lymph tissue, then we would not use the left arm. And it is okay to use the right arm, it is just probably more accurate.

Okay.

It also needs to be next to the skin as well, so we do not go through clothing.

Yeah. What about the size of the cuff?

So the size of the cuff, it should cover at least 80% of the distance between your axilla there and your elbow, so 80% of your upper arm at least. So we are probably exactly right there.

And then the blow-up portion of the cuff here should, in terms of circumference, cover at least 40% of the circumference of your upper arm there.

I notice it does say that it is this side to the patient, so that is important that it go right way around.

Correct, yeah. And then on the other side, of course, we have the arrow here pointing to the artery. So this will be pointing to your brachial artery right here, which is just on the medial side of the elbow right there. So placing the cuff, we know it is the right size, the arrow is pointing to the brachial artery, directly to the skin, make sure that there is no skin being pinched, it is a nice snug fit, not too tight, and the patient can then... You can relax your arm, just let it dangle, same height as your heart. And then it is important that you do not move your arm at this point as well, because really the cuff is listening to the beats, it is listening to the pulses, so if it hears anything that may be mistaken as a pulse, it might read that erroneously. So we will take your blood pressure now. Are you okay?

Absolutely fine.

Cuff is blowing up. So it is listening to your pulse. So if a patient has an irregular pulse, sometimes an automatic cuff will not understand the beats of the heart, or the beats of the pulse, in that case, it is good to do manual blood pressure.

Anybody with an irregular pulse, it is good practice to do manual blood pressure.

What about age? Does it affect the elderly more with smaller arms or thin tissue and stuff like that? Do we have to be careful on how tight it blows or anything?

Yeah. As long as the size is okay, the 80% and the 40% measurements are okay, the skin, older people's skin, gets a lot thinner and more likely to tear so we have to be careful. Historically, a piece of cloth used to be put underneath the blood pressure cuff. We do not do that these days but yeah, you have to be careful. And really, if I am taking blood pressure and I see the cuff going very, very high and not stopping, and obviously patient's in quite a bit of discomfort and maybe even pain with this, then I would switch it off and see why that is happening.

Yeah. I have heard in the past that the elderly, if you blow them up too tight, they can get quite severe bruising and this sort of stuff, so that is really operator error, not the cuff's fault, it is the person using it that's blowing it too tight basically.

And of course, if people are on blood thinners, it is going to happen as well. It is going to happen, even an aspirin a day is going to give you the propensity to bruise, yeah.

Mark, what are we looking for on the screen? What is the screen actually telling us?

The screen is telling us your blood pressure there, the top number which is the systolic and the bottom number which is the diastolic. So the top number is when your heart is actually beating and creating force against your artery, the walls of your artery. And the bottom number is when the heart relaxes there, the diastolic. For an adult, it is... Textbook is 120 over 80, so that is a really good blood pressure right there. Your blood pressure does go up as you get older and you need to be aware of the different stages with the development of a human and what the blood pressure needs to be for that particular age group. Also need to take into consideration, older people, or anybody really, could be on blood pressure medication that artificially lowers their blood pressure. So if you were on blood pressure medication and we saw that this was an appropriate blood pressure for you if you were a lot older, if you were probably 80 years old, it would be an artificial reading. If you did not take the blood pressure reading, perhaps your blood pressure would be much higher. So it is what is normal for each individual patient depending on their... An athlete will have a lower blood pressure, an older person will have a higher blood pressure, what medication they are taking.

So I think what you are saying then is really, you have got to take into consideration an awful lot of factors. A blood pressure alone does not tell you a lot, it is the history, it is the medication history, it is the age, it is the size, all of them go together to give you a decent diagnostic tool.

That is right. And we do not take blood pressure on its own as a single measurement, pulse must be taken at the same time as well. All of the observations, the vital signs feed in to create a picture.

So again, I think what you are saying is, we are actually creating this picture from a group of observations and the groups of signs and symptoms and histories, that is what the computer, once we input it, it gives us our pathway from.

That is right, that is right. So I have your blood pressure. I will remove my gloves, I will clean them with the alcohol gel, then I will input your blood pressure onto the computer. That was taking a blood pressure.