Copyright Goodheart-Willcox Co., Inc. Chapter 18 Vital Signs, Height, and Weight 477 17. Squeeze the cuff to expel any remaining air. 18. With your fingertips, locate the brachial artery at the inner aspect of the elbow (Figure 18.30). Figure 18.30 19. Wrap the cuff smoothly and snugly around the exposed arm about 1 inch above the elbow. Do not wrap the cuff around clothing. Make sure the cuff is not too snug (Figure 18.31). Figure 18.31 20. Place the center of the cuff, usually marked with an arrow, above the brachial artery. (Figure 18.32). Figure 18.32 21. Close the valve on the bulb of the sphygmomanometer by turning it clockwise. Be careful not to turn it too tightly. 22. Place the earpieces of the stethoscope in your ears. 23. Find the brachial pulse. 24. Place the warmed diaphragm of the stethoscope over the brachial artery. 25. If using a manual aneroid sphygmomanometer, keep the measuring scale level with your eyes. 26. Inflate the cuff to 180 mmHg. You should not be able to hear the resident’s pulse. If you do, inflate the cuff to 200 mmHg. Best Practice The stethoscope diaphragm should be held firmly against the skin close to the cuff, but should not be placed under the cuff (Figure 18.33). Figure 18.33 27. Deflate the cuff by slowly turning the valve on the bulb of the sphygmomanometer counterclockwise at an even rate of 2–4 millimeters per second. 28. Listen carefully while the cuff is deflating. Note the dial reading when you hear the first sound (beat). This is the systolic blood pressure. 29. Continue deflating the cuff slowly and evenly. Note the dial reading when the sound (beat) disappears. This is the diastolic blood pressure. 30. Remove the stethoscope earpieces from your ears. Completely deflate the cuff and remove it from the arm. (continued)