Page 1 of 1: OSCE-Buster: BP of girl who was complaining of dizziness

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

i was asked to take the BP of this girl who was complaining of dizziness upon standing up.

I went in, after getting permission from the examiner, i greeted the patient, asked her how she's feeling and just plainly told her that i'm here to check your blood pressure and will explain the procedure as i do it.

i asked her if she has any pain in any of her arms or a preference on which arm to check the blood pressure.

i asked if she has any pain or difficulty upon standing, she said yes, i just told her, ok then i will assist you when you stand up.

palpated for the brachial artery.

there are three cuffs only, one is for children, one for adults, and one for obese patients, i don't suggest wasting time in finding out which cuff to use, so unless the patient is very obese or very frail, just pick up the normal cuff, if you want to be very meticulous, you can check it along the arm circumference too.

connect the cuff to the instrument, its not a hard job, if you keep your cool, there's only one place on the instrument where a cuff can be connected, so you do that, but not too tightly so that the examiner is cursing you when he dismantles it for the next candidate

make sure the mark for artery is over the brachial artery.

now you tell the patient that i'm going to inflate this cuff which might feel a little uncomfortable, and i will feel for your pulse while inflating, and will listen with this stethoscope when i will be deflating it, saying this much is enough

palpate the radial pulse while inflating and auscultate while deflating, deflation might seem tricky if you're seeing that instrument for the first time, there is a red knob on the rubber pump with which we inflate, if you just lightly press the knob and release it, it will deflate a little, deflate slowly, but not at a turtle's speed. make sure you're at the eye-level of the dial when looking at it. now if you want, you can write down the reading as well. i didn't..

deflate completely and tell the patient that you would also check the pressure when she's standing. support the patient as you had promised earlier, and inflate while palpating the radial artery. i sat down while deflating so that i was at eye level with the dial when looking at it, again i didn't write down my readings.

deflate and remove the cuff and thank the patient.

tell the examiner about your readings.

i was done well before the 4:30 bell rang, so i had to sit in the room with the examiner and the simulator. during this time i was able to peep at the marking sheet that the examiner had in his hand and it had 4 headings on it. they were:

- examination technique
- conclusion
- fluency
- approach to the patient

i think this goes for at least every examination session and we should keep this in mind when preparing for the PLAB . we should try that every station goes fluently, and also that our approach to the patient is good. so practise the grips, and phrase your questions well, and be gentle in your movements/manipulations.

thats it for BP, will be back with the next station.

take care,

wolf

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

hey wolf,

just a silly doubt, in the BP we are asked to have the bp cuff "at the level of the heart",so in sitting position do we ask the pt to lift the arm slightly? Do suggest coz i had this doubt since a long time.

bye, carry on with the statiions,we are ready to copy-paste it as word documents

Shreee

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

hi shreedhar,

i don't think arterial blood pressure has any variation with regards to the cuff being at the level of the heart. i don't think it is mentioned in mcleod's, and i never paid any mind to it when i checked the bp in PLAB . so i guess its not a big deal.

any comments....

take care,

wolf

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

thanks wolf,

yes its not mentioned in McLeods and as it is an arterial BP measurement which is "pressure exerted by the blood on the lateral walls of the artery" it should vary much in regard to arm positioning, atleast for clinical measurements.

thanks ur post was an eye opener

Shree

bindasnikhilg · Credits: 45003 My Scrapbook

WELL THAT WAS VERY WELL ASSIMILATED INFO,UR LUCKY THE EXAMINER DIDNT CATCH U PEEKING INTO HIS SHEET,HAHAHAHA

James444 · Credits: 932 My Scrapbook

Hi, thanks for that detailed description of BP taking technique. However when we are taking the BP with the patient standing, should we ask the patient to raise his arm to the level of the heart, and supported by his other arm? Or should we leave the arm hanging by the side?

dr999 · Credits: 2105 My Scrapbook

i think you should have mentioned about sitting down without even telling me if she the patient feels dizziy.

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