1. How to Take a Paradoxical Pulse
John Nation
Austin Community College
Spring 2010

2. Step 1- Inflate cuff well above when Korotkoff sounds are last heard
Hint: Just as you would when manually taking a blood pressure

3. Step 2
Slowly deflate the cuff until Korotkoff sounds are heard only during early expiration (the sounds disappear with inspiration)
Record this number!
Deflate cuff until Korotkoff sounds heard only during expiration.

4. Step 3
Continue to deflate the cuff very slowly (about 1mmHg at a time) until Korotkoff sounds are heard with even intensity during both expiration and inspiration
Record this number!
Deflate the cuff very slowly until Korotkoff sounds are heard during inspiration and expiration

5. Step 4
Take the first number (the systolic blood pressure when Korotkoff sounds could be heard during early expiration only) minus the second number (when Korotkoff sounds can be heard evenly during expiration and inspiration)
If Reading #1 – Reading #2 = > 10mmHg, this is a signifcant finding.

6. An Example Here’s an example:
The RN inflates the blood pressure cuff well past when Korotkoff sounds are no longer heard
The cuff is slowly deflated until the RN can hear Korotkoff sounds during expiration only. She/he looks at the sphygmomanometer and records the pressure at 140 mmHg
The RN continues to deflate the cuff very slowly until Korotkoff sounds are heard evenly during expiration and inspiration. She/he looks at the sphygmomanometer and records the pressure at 120 mmHg
The first reading of 140 mmHg (when Korotkoff’s sounds first heard during expiration only) minus the second reading of 120 mmHg (when Korotkoff’s sounds are first heard evenly during inspiration and expiration) is the paradoxical pulse.
140 mmHg- 120 mmHg = 20 mmHg. This would be a significant finding in this example.