we see this alot..especially in the inpatient side.. when an aide reports
both sides as the same ( I bet that she never even took the one BP).. she
just looked at the BP from the day before. We get the patient and can't
even find a BP on one arm.
> -----Original Message-----
> From: Richard A. Wyrens [SMTP:[log in to unmask]]
> Sent: Monday, November 25, 2002 9:46 AM
> To: [log in to unmask]
> Subject: Re: Which arm?
> 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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