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November 2002

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From:
"Needham, Terry" <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Mon, 25 Nov 2002 10:59:49 -0500
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I do several BP screenings (stethoscope, not Doppler) each month as part of our community education program - bilaterally of course.  I explain the reason being that left and right pressures may not be equal, whereupon the majority (certainly >90%) remark that they have never had arm pressures measured bilaterally. Perhaps then the percentage of physicians who do not measure BP's bilaterally, is similar?

-----Original Message-----
From: Richard A. Wyrens [mailto:[log in to unmask]]
Sent: Monday, November 25, 2002 10:46 AM
To: [log in to unmask]
Subject: Re: Which arm?


Don,
   Educate is the word. I've always been a strong proponent that a
complete physicial exam of a patient in a physician office should be
required to include bilateral arm pressures...what's an extra 15
seconds?  What do you think the % of physicians that don't do bilateral
pressures is ???    Ric Wyrens  BS, RVT

Don Ridgway wrote:

> Here's something I've run into periodically and wish we could get the
> word out about somehow:
>
> Not often, but occasionally, I see a patient with a significant
> difference between brachial pressures from right to left, usually of
> course lower on the left. (I've read that subclavian artery stenosis
> leading to a vertebral steal occurs on the left 85% of the time, on
> the right 15%, and we all see something like this proportion in our
> work.) And the patient will tell me they're being medicated for
> hypertension, based on the left-arm pressures.
>
> Nurses seem to learn the prevailing common wisdom on this, which is
> that the left arm is closer to the heart (not really) and that's the
> arm one uses for representative blood pressure measurements. There's
> a nationally-sponsored stroke screening program done by nurses--BP,
> check cholesterol, listen for bruits--for which the instructions
> specifically state "use the left arm." When I told the nurse running
> this that the right arm was much more likely to represent systemic
> pressure, she didn't believe me.
>
> Anyone else seeing this? I wonder how many patients are being treated
> based on falsely-low BP readings.
>
> Don Ridgway
> Grossmont Hospital
> Grossmont College
>
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