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First Responder Training

How To Take A Blood Pressure

    Not everyone knows how to take a BP or can easily get frazzled when the situation arises and they need to take a vital sign for a medical emergency. Blood pressure is a good indicator of something serious in the event of a trauma or illness, such as internal bleeding. We often take them in a series to find a trend and gague what is going on with the body systems. You only get better with practice; I know I take at least a few per week when I'm at work. Taking a BP is easy and quickly completed, usually in only a minute or so when done correctly.

 GENERAL INFORMATION:  What is blood pressure?

    Blood pressure (BP) is the force or pressure that carries blood to all parts of the body. A blood pressure reading is the pressure that blood puts on the walls of arteries. There are 2 parts to a blood pressure. One is called systolic (sis-TALL-ik), and is the top or the first number in a blood pressure reading. The other number is called the diastolic (di-uh-STALL-ik) and is the bottom or second number in the reading. An example of a blood pressure reading is 120/80 (120 over 80). In this example, 120 is the systolic number and 80 is the diastolic number.

    The systolic (top) number is the peak blood pressure when the heart is beating or squeezing out blood. The diastolic (bottom) number is the pressure when your heart is filling with blood or resting between beats. 

    High blood pressure
is a systolic number of 140 or higher, or a diastolic number of 90 or higher (140/90). Normal blood pressure is a systolic number less than 130, and a diastolic number below 85 (120/80). High normal blood pressure is a systolic number between 130 to 139, or a diastolic number between 85-89. (135/85). 

    Why do you need to take your blood pressure?
You may need to have your blood pressure taken because you have high or low blood pressure.

    Usually, there are no symptoms with high blood pressure . The only way to know if you have high blood pressure is to have it checked. High blood pressure can cause damage to your blood vessels (arteries). This damage may make it more likely for you to have a stroke, heart attack, or kidney disease.

    Low blood pressure
may cause you to feel dizzy or feel like you are going to faint (pass out). This may happen when you go from a sitting or lying position to a standing position. Your caregiver may want to have your blood pressure checked to find out if it is low.

    Using a sphygmomanometer (sfig-mo-man-OM-i-ter) and a stethoscope (STETH-uh-skop): A sphygmomanometer is a device for measuring blood pressure (BP cuff). It includes an inflatable cuff, inflating bulb, and a gauge showing the blood pressure. The stethoscope has 2 earpieces, tubing, and a diaphragm (DI-uh-fram) (flat disk at the end). It is used for listening to sounds from the body. Carefully read the directions before using your blood pressure kit. Each blood pressure kit may work in a different way.

The following steps may be helpful to take a blood pressure:

- Sit up or lie down with the arm stretched out. The arm should be level with the heart.

- Put the cuff about 1 inch (2.5 cm) above the elbow. Wrap the cuff snugly around the arm. The blood pressure reading may not be correct if the cuff is too loose.

- Put the earpieces in your ears.

- Using your middle (long) and index (pointer) fingers, gently feel for the pulse in the bend of the elbow, below the bicep muscle. This is the brachial (BRA-kee-ull) artery, running through the in (medial) side. You will feel the pulse beating when you find it. Do not use your thumb to feel for the pulse because your thumb has a pulse of its own.

- Put the diaphragm of the stethoscope over the brachial artery pulse. Listen for the heartbeat.

- Tighten the screw on the bulb and quickly squeeze and pump the bulb. This will cause the cuff to tighten.

- Keep squeezing the bulb until the scale on the gauge reads about 160. Or, until the gauge reads at least 10 points higher than when you last hear the heartbeat. If your patient is an elderly person who has a history of hypertension (high BP), I recommend starting higher, perhaps in the 200s. Last week I had a guy who was around 220/100.

- Slowly loosen the screw to let air escape from the cuff. Let the gauge fall about 5 points a second. Carefully look at the gauge and listen to the sounds. Remember the number on the gauge where you first heard the thumping sound.

- Continue to listen and read the gauge at the point where the sound stops.

The number of the first sound is the systolic (top number) pressure...fun fact: this is not the actual heartbeat- it is the squirting of the blood through the artery. The second number is the diastolic (bottom number) pressure.(this is the noise of the blood refilling the chambers of the heart before it pumps again.)

- Write down your BP, the date, the time, and which arm was used to take the BP. Let the air out of the cuff.

Helpful tips:

Do not take a blood pressure on an injured arm or an arm that has an IV or a shunt. A woman who has had a breast removed should have her BP taken on the opposite arm

Usually a blood pressure should be taken when a person is rested and relaxed. It should not be taken right after exercising or if the person is feeling stressed.

Ask the person to sit or lie down for about 2 minutes with the arm stretched out. The person should be relaxed.

If you can not feel the pulse, try using the stethoscope. Put the diaphragm of the stethoscope over the bend in the arm. Tighten the screw on the bulb. Squeeze the bulb of the cuff until you see the number 160 on the blood pressure gauge. Slowly loosen the screw on the bulb and listen for the pulse. You may need to move the diaphragm around a bit until you find the pulse. If you cannot hear the pulse, check the reading of the last blood pressure. Then, pump the cuff 10 to 20 points higher than that reading.

       For more helpful info, http://www.drugs.com/cg/how-to-take-a-blood-pressure.html


    Ok folks, I'd like to spend a few minutes on a basic rescue skill that can easily make the difference between life and death for your patient (forthwith referred to as "pt."). In this age of longevity and an endless array of conditions pt.'s may be receiving treatment for, the odds you will happen upon a medical emergency is not just likely, it is practically mathematical certainty.


    In the event you a required to perform cardiopulmonary resuscitation (CPR) you are involved in a true medical emergency. Here are some steps to ensure you are providing the best care possible in this situation.


First of all, before anything else is attempted, contact emergency services immediately. Designate someone nearby with a cellular phone to dial 911 while you provide treatment.



A. Is this scene safe? Are you arriving on a car wreck or entering into a crime scene? Remain calm and take measure to protect yourself FIRST.  IE: If you run into a busy 4 lane highway to assist a civilian and are thusly struck by an oncoming mail truck, you have just doubled the work of the Paramedics who are already en route. Do not make more work for them and therefore stretching their resources thinner, decreasing the odds you or your pt will make it out of this alive. Keep your wits about you and fight the urge to sprint blindly into an unknown and, more importantly, Unsafe environment.


B. BSI (body substance isolation) This is the theory you must operate on that goes something like this: if it comes out of their body, it IS infectious. With the unpredictable and unknown medical history of the pt you have just encountered, you could easily come in contact with deadly disease that will certainly end your career as a public servant or ever living long enough to see your own grandchildren. Simple precautions like latex or vinyl gloves and a one-way rescuer mask are life savers for you and the pt.  Not only are they highly compact and stowable in your utility belt, they are very cost effective. For examples, see:



2. Re-learning your ABC's. There are a few key findings you need to discover upon arrival.

A. Airway-is their airway open? Do you see an obstruction? Children often choke on small objects, causing respiratory distress and as a result cardiac arrest. If you are able, attempt to tilt the head so that the tongue is not blocking the airway. This is the most simple but effective method to open an airway.


B. Breathing- are they breathing? What is its quality, rate? Do you hear any unusual noises upon respirations?


C. Circulation- do you detect a pulse? Is it fast/slow/strong/weak? Do you find any bleeding that might lead to shock? If you should discover massive, spurting bleeding, the pt has likely severed an artery and will bleed out very soon. Refer back to BSI and with a gloved hand, provide direct pressure on the site or clamp down on a pressure point to slow the flow to the wound.


3. After you have quickly made these assessments, move quickly into CPR. NOTE: these steps are to be performed ONLY if the following indications are present. They are UNCONSCIOUS, have NO pulse & they are NOT breathing.

* Using a one way mask, provide two (x2) ventilations (breaths) for about one or two seconds and watch for the chest to rise with the breath. If you do not see a rise, reposition their head, and check their airway for an obstruction. Try the ventilations again.

* Make a fist and grab it with the other hand, placing both over the center of the sternum (breastbone). The pt MUST be on a flat, firm surface or the thrusts will be ineffective in making the heart pump as you press inward. To provide adequate compressions, you should do 30 rapid thrusts about 2" downward. Then follow with 2 more rescue breaths, and continue alternating. 2 breaths/ 30 compressions. For a good visual example, view this video from YouTube:


    I was originally taught a slightly different method for the compression/breath ratio (at 15:2), but my understanding is that has changed for some fire-rescue protocol. The reason this has begun to change is the idea that performing more chest compressions will allow the patient's blood pressure to increase while you are circulating their blood, thus their cells will perfuse (cellular respiration) better. the whole point of CPR is to keep their tissues alive until advanced medical care can be given.

    The theory behind all of this, of course, is to keep pumping oxygen through the bloodstream, which will help keep the brain, heart, and other vital organs alive long enough to get your pt to advanced medical care. FUN FACT: Your patient ought to be receiving at least 16-18% O2 with the rescue breaths Assuming atmospheric conditions are neutral (average elevation), the earth's air has about 21% O2. When we breathe, we only absorb approximately 5%, leaving a large remaining portion unused.

    This blog is to be considered the most basic of overviews regarding CPR. There are several different protocols depending on various situations. The only thing common in every medical emergency is unpredictability. Also, there is no replacement for sanctioned and official training from a heath-care provider or instructor. So in a pinch, this will work, but you are far more effective when you know what you are doing and why. By enrolling in at least a Red Cross CPR class, you will obtain some basic life saving skills & you won't need to re-certify for a year or two. If you find you enjoy that, I encourage you continue on to First Responder level, Emergency Medical Technician, and/or Paramedic. All of these provide a great educational benefit of understanding the methods and interventions you're providing.


    Check out the Red Cross website to get info on certification:



Medical Emergencies: Controlling bleeding

    A quick foreward, remember what I have said about body substance isolation. When blood is involved, ALWAYS wear protective gloves. Moving on....

    Regardless how severe, all bleeding can be controlled. If left uncontrolled, bleeding may lead to shock or even death. Most bleeding can be stopped before the ambulance arrives at the scene. While you're performing the steps for controlling bleeding, you should also be calling for an ambulance to respond. Bleeding control is only part of the equation. For tips on summoning an ambulance, check out Calling for Help.

    The first step in controlling a bleeding wound is to plug the hole. Blood needs to clot in order to start the healing process and stop the bleeding. Just like ice won't form on the rapids of a river, blood will not coagulate when it's flowing.

    The best way to stop it is to...stop it. Put pressure directly on the wound. If you have some type of gauze, use it. Gauze pads hold the blood on the wound and help the components of the blood to stick together, promoting clotting. If you don't have gauze, terrycloth towels work almost as well. If the gauze or towel soaks through with blood, add another layer. Never take off the gauze. Peeling blood soaked gauze off a wound removes vital clotting agents and encourages bleeding to resume.

    Gravity makes blood flow down easier than it flows up. If you hold one hand above your head and the other at your side, the lower hand will be red while the higher one is pale. Step two to control bleeding uses this principle. Elevate the wound above the heart. By elevating the wound, you slow the flow of blood. As the blood slows, it becomes easier to stop it with direct pressure. Remember, it must be above the heart and you must keep direct pressure on it.

    Pressure points are areas of the body where blood vessels run close to the surface. By pressing on these blood vessels, blood flow further away will be slowed, allowing direct pressure to stop bleeding. When using pressure points, make sure you are pressing on a point closer to the heart than the wound. Pressing on a blood vessel further from the heart than the wound will have no effect on the bleeding.

Common pressure points:

  • Arm between shoulder and elbow - brachial artery (E)
  • Groin area along bikini line - femoral artery (H, I)
  • Behind the knee - popliteal artery (J)
  • Photobucket

    Remember to keep the wound elevated above the heart and keep pressure directly on the wound.

    When should you apply a tourniquet? The simple answer: almost never. Tourniquets severely restrict or occlude blood flow to the arm or leg to which they are applied. Using a tourniquet to stop bleeding has the potential to damage the entire arm or leg. Patients have been known to lose limbs from the use of tourniquets. Often, if a tourniquet doesn't cause a loss of function on the extremity which has it, then it probably wasn't applied correctly. Applying a tourniquet is a desperate move - only for the direst emergencies where the choice between life and limb must be made.

    For a step-by-step guide, see How to Use a Tourniquet.

    Using a tourniquet requires wrapping a cravat (non stretchy material like terry cloth or linen) around an extremity and tightening it with the use of a windlass stuck through the bandage (see photo). The tourniquet should be tightened until the wound stops bleeding. If there is any bleeding at the wound after placing a tourniquet, then the tourniquet must be tightened.

    When a tourniquet is applied, it is important to note the time of application and write that time down somewhere handy. The best bet is to write the time on the patient's forehead with a water-proof marker.

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