Bad Blood Pressure Measurement Is Killing Our Patients | AMA 29

Bad Blood Pressure Measurement Is Killing Our Patients | AMA 29

hey what's up z-pak it's your boy dr. Zuber nemanja AKA z dog md it's chaos over here I apologize but it raises my blood pressure to be in active construction zone which is what I'm talking about today which is blood pressure measurements listen by current definitions like something like 50% of Americans have high blood pressure this is insane especially in light of the fact that we most often measure it wrong especially healthcare professionals who should know better so here it just it kills me that we're making life-and-death decisions putting people on medications giving them a stigma of a disease affecting their life insurance but and we're not even measuring blood pressure right here is how you measure blood pressure and I want you to listen in and take notes especially if you're a student okay even if you're not first of all when you measure blood pressure you better pick the right cuff size if the cup is too big or too small you're gonna get the RO Gnaeus readings okay it should fit comfortably around the arm do not put it over close the shirt should come off there should be it should be over bare skin alright when you check a blood pressure cuz people are stressed they're walking in they've been waiting in the lobby they're crazy five minutes of quiet time before you check the pressure now this is really hard in our chaotic healthcare environment but if we're gonna make life-and-death decisions we need to elite Leo it to our patients to do it correctly okay make sure the room isn't too cold or too hot make sure the patient has avoided their bladder make sure that they're not going crazy with construction & Remodeling and make sure that you take the blood pressure with the feet flat on the ground okay the back support it in a chair right back support it in the chair right Eric that's right you take you take the pressure with the arm at heart level supported on something okay because otherwise you're gonna get erroneous readings and you want to do it two measurements roughly you know a couple minutes apart and if those measurements differ by more than a few millimeters of mercury you probably want to take a third measurement remember that blood pressure varies over the course of the day and so you may want to check it in the morning you may want to check it at night check it at home teach your patients how to do this at home because people get white coat hypertension and then they're treated for something that maybe they don't have it's very very important now remember that key things are if the back isn't supported if the feet aren't flat don't let the legs be crossed stop talking to your patient when you're checking their blood pressure tell them to be quiet talking will change the blood pressure now look at my blood pressure it's going through the roof right now because they're drilling in my house probably we're gonna hit a gas main and explode this is the wrong time to check my blood pressure all right let me chill for five minutes now listen why is this important nurses and doctors and mas people who are checking blood pressure patients at home if you screw this up it's a life-and-death thing if I start you on hydrochlorothiazide and lisinopril because I think your blood pressure is high and it's not I am doing you a disservice you may pass out you may have syncope you may hurt your kidneys why because I screwed up so guys here's the call to action we did a longer video on this there's plenty of resources online on how to take a correct blood pressure the machines by the way are not bad sometimes it's helpful to put a patient in a room and have the Machine check it because then you lose a little bit of the white coat aspect so there's a lot of nuance here but the bottom line is just check the damn blood pressure right and the other thing is check the pressure that's a key thing right so many people just don't aren't even screened alright guys I love you become a supporter of the show you can subscribe we get crazy uncensored content you can send us these little stars which are like a tip jar that goes to by Logan's adult diapers and Tom's Bitcoin so the main thing we want from you though is please share this video because we're trying to change the practice of medicine for the better for all of us alright guys I love you I'm gonna go see what's blowing up what's blowing up nothing that's good I'm out

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34 thoughts on “Bad Blood Pressure Measurement Is Killing Our Patients | AMA 29

  1. I wish I could take bps with optimal circumstances. Unfortunately, I work a jail and I have take it when people are in handcuffs, over the clothes, while they could be yelling for our initial assessments.

  2. All true. I complained that my clinic had a radio blasting loud music of an aggressive tone in the waiting room. BP was 210/105 by the time I was in the chair. (I do suffer anxiety) so staff had to be updated on this to provide a calmer waiting room. Now a TV shows videos of general health advice with a soft tone. Big improvement.

  3. Forget putting the cuff on skin, the Stethoscope absolutely must be on skin! Also it's probably worth mentioning that a lot, trending to most Americans are getting really really skeptical of that "50% of americans have high BP" bit. See for most of us, Our BP has not really changed since we were teenagers. But suddenly the baseline BP for the past 100+ years, 120/80 is "High Blood Pressure". Uh huh! sure it is. Are you trying to tell me that the reasonable observer should not be concluding that the definitions of "illness" are being revised downwards in order to push ever more pharmaceuticals? Because quite frankly we see this scam rampant at every level of the health care industry. Things like the ACR mandating Radiologists use "diagnostic monitors" that grossly exceed the human eyeballs ability to perceive, and have a brightness level so intense that it will actually cause physical damage to the radiologists eyes in normal use. All because the monitor specifications are being written for the ACR by the Medical Device manufacturers, who are trying to prevent Doctors from using $200 off the retail shelf screens that are superior in every way to what they have been using for the past decade, and instead forcing the hospitals to buy $13000 monitors that have no measurable benefit (and the high potential for harm to the long term user). Medicine has gone insane in a lot of ways.

  4. I was misdiagnosed with HBP a year ago. Took the prescription to a Walgreens pharmacist. Before he checked my blood pressure, he was running around gathering the equipment like the place was on fire. Then, he checked my BP. It was high because I was watching him race around like a maniac. After the reading, he was calm and acted like he had all the time in the world! Is this a "tactic" some people use? I hope not! I already had a prescription. Was only on meds for a month before I realized it wasn't necessary for me. Physician Assistant was way to quick to diagnose HBP in my case.

  5. If I send you my cardiologist's fax number, will you send him a link to this video? I swear each time they take my blood pressure it's different. They had me take my own blood pressure for a month at home. Not once was it the same. After I figured out how to do it my blood pressure stayed relatively stable but in the doctor's office it's up and down. And they get offended when you ask them how often they get their blood pressure equipment checked. How f-cked up is that?

    The problem with many doctors offices is that they have so many patients that it's like a fast food drive through. They seem to want to get as many patients in and out the door in order to get to the next one in line.

  6. The solution is not to give potentially toxic drugs to lower people's blood pressure, but to tell them that they can do so themselves over a few months by eating a whole-food plant based diet with no added salt.

    But that would be bad for business, unfortunately.

  7. I don't think it's fair to put it all on the clinicians. The problem isn't always about a lack of understanding the optimal way to check BP – there's also that the provider is required to have the patient encounter done in 18 minutes which includes the LVN taking 5+ min to do vitals and basic screening questions added to the patient arriving 9 minutes late because they wanted to take a bathroom detour.
    And, if I'm convinced that a major part of the problem is white coat HTN and send the patient home to do home BP checks, suddenly I have to worry about my performance metrics showing that I let a patient with elevated blood pressure go home with no medication adjustments. It's the same for diabetic patients with HbA1c > 10 who refuse to get on insulin (or lose weight) or high risk patients who refuse statins; I get flagged about all those patients who aren't under control. With every one of them I document exhaustively, case by case, how I approached education with appropriate follow-up (which presumes patient compliance) and, even then, there's no guarantee that my metrics wouldn't be adversely affected. In that setting I don't blame a lot of docs from simply erring on the side of treating. The point is that policy needs to support the physician's right to apply some degree of professional judgement instead of putting pressure to practice medicine with a blind adherence to statistical guidelines. This is why medicine is not just a job – it's a professional practice. That's why patients aren't just about their demographics – they're individuals with unique issues and needs.
    But, yeah, it would be great to have my patient waiting in the exam room sitting on a bean bag with Windham Hill piped into the clinic and 20 min allocated just for checking their BP.

  8. Thanks, Z-doggMD. Correct room temperature and emptying the bladder aren't always practical in all settings but BP prescriptions are also not often given in those settings either (eg. ED). Also, a few mmHg doesn't seem that statistically significant (unless the BP significantly out of normal range). …great tips on the cuff and uncrossing the legs. I'm often asking patients to uncross legs. I would add: watch the arm movement and make sure they are relaxing it and not moving the arm around. Thanks for the Vlog!

  9. I can tell you a lot of nurses have been taking my blood pressure over my clothes and they take it so fast I’m sure it’s not right. I think I had one nurse within the last month take my blood pressure right, one.

  10. I've had lots of nurses measure my pulse wrong and just write down some BS number. With BP, I ALWAYS offer to take my cardigan off and they ALWAYS say, "No, that's alright.' Like, why?

  11. I just love it (not) when they call my name, I book it down the hall, they sit me down and take my blood pressure. Hey dude, you're supposed to give me a few minutes to return to rest. And that's why the doctor makes you retake it after I have been sitting and relaxing. Don't take the BP after the sprint! 🏃

  12. And it's not just people lives, it can be their livelihoods too. I have trouble maintaining my CDL medical because everytime I go for a physical my blood pressure shoots up. Its a stressful thing, my job is on the line even though I know my blood pressure is perfectly normal at home.

  13. Choosing to ignore studies like this are what's killing your patients:

  14. I wish there was mentioning of parameters regarding blood prressuee cuff. Like children bladder cuff widtg needs 80-100 circ of arm and length should be 40% of their circumference.

  15. This video really needs to be shared with hospitals (in room measurement and ER). I've been the one with the cuff on and I've seen and experienced the things you said should not happen. Most of the time … at least 80% plus, my arm has NEVER been as you say it should … my arm usually resting on the bed (I'm sitting up) . I'm going to my Cardio Dr. in a few days and I'm going to pay close attention!! Thank you for this video!!! My daughter is a cardiac nurse … guess who will be tested!!!

  16. I'm an RN now, but I was a CNA for about 6 years while I put myself through school. I worked under several nurses on a surgical floor that wouldnt accept a high BP reading. They made me check every limb, and multiple cuff sizes until I got a read they liked. Seriously pissed me off. Which number was the right one? Nuts.

  17. I had to laugh, my feet are never flat on the floor when they take my blood pressure. I'm 4' 11" and my feet never touch the floor in any chair I sit in (unless it's made for kids).

  18. Use the correct size BP cuff. The ideal cuff length is ≥ 80 percent of the patient’s arm circumference. The ideal cuff width is ≥ 40 percent of the patient’s arm circumference.

  19. My doctor doesn't care. I'm the one that had to show her that I had high blood pressure and then she put me on medication and it still didn't bring my blood pressure down so I told her I needed adjusted and she still ignores me. I'm sure I will die of a heart attack because I can't get a doctor to listen to me. Doctors don't listen to patients anymore.

  20. What about the automatic cuffs nurses use in dr's offices? Those things get sooo tight, I end up grimacing and holding my breath.
    Should they be that tight? When I ask about it, I am told its so they get a good reading.

  21. I try not to get my BP checked as I absolutely hate getting it done..
    ( rather get a blood test )
    I always feel my arm is gonna explode & esp when it's a student & they have to repeat it twice & the cuff stays inflated for what seems like a long time..

  22. Man, I totally agree. I had my blood pressure taken once the day after a marathon. Skipped the night of sleep due to travel. I told them all those things. They did all those things you mentioned wrong, then told me to eat more greens, stop drinking alcohol, all sorts of crap. I don't drink, eat lots of greens. Tried to tell me I needed blood thinners. Jerks. I don't trust medical people anymore. I cancelled my health care and used the money to buy a corvette – much happier now.

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