How to measure Pulsus Paradoxus
- Step 1: Take a normal manual blood pressure to determine the patient's SBP and remind yourself what their Kortotkoff sounds are like
- Step 2: Inflate the BP cuff to higher than their normal SBP
- Step 3: Lower the cuff very slowly until you only intermittently hear the Kortotkoff sounds; I often will let the air naturally deflate out of the cuff to get this number. Record the number at this point as Point 1.
- Step 4: Continue lowering the cuff until you hear the Kortotkoff sounds coming through at all times (both inspiration and expiration). Record this as Point 2.
- Step 5: The difference in mmHg between Point 1 and Point 2 is your pulsus paradoxus value. Typically a value <10mmHg is considered normal (not hemodynamically significant)
by Dr. Surbhi Singhal @Surbhi_Singhal2
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