During the surgery, the thin woman's blood pressure remained high. It turned out to be a problem with the blood pressure cuff.

At the Monday morning meeting, the director was furious again. The reason for his anger this time was mainly because he criticized the teaching problems of several of us senior doctors.

Last week, an intern nearly caused a major problem with anesthesia by using the wrong blood pressure cuff.

Here's what happened: The patient that day was a woman, probably in her 20s, very thin. She was nearly 1.7 meters tall and weighed only 40 kilograms. Her arms looked like those of a child. The intern saw that she was too thin, so he replaced the adult cuff.

In his opinion, the cuff was too big for her. After changing to a pediatric cuff, it seemed to fit perfectly. We did not notice this detail when we were teaching. In this way, anesthesia began. However, even during the anesthesia induction stage, blood pressure remained high.

At the time, we were puzzled: a girl in her 20s shouldn't have such high blood pressure. Besides, we had seen her various tests before the operation and asked her in detail during the visit, but we didn't find any signs that her blood pressure might be high.

After all the investigations were fruitless, we thought she was resistant to anesthesia. Although we generally do not accept the term "resistant to anesthesia" from an anesthesia professional perspective, we do often encounter particularly severe cases. So we increased the dose of anesthesia.

However, after a series of operations, we found an abnormality: as the depth of anesthesia increased, her pulse oxygen saturation waveform was getting lower and lower. Obviously, the blood pressure at this time was almost affecting the perfusion of her organs. Once the perfusion was affected, it was likely to cause organ function decline. At that time, it might not only affect the safety of anesthesia, but also bring serious conditions to the patient. So we checked the cause again.

This time, when I reached under the surgical towel wrapped around her arm, I immediately found the problem: the cuff was wrong! It was like an experienced driver's instinctive reaction. When I touched it, the cuff that was supposed to be wide seemed to be gone. When I touched it carefully, there was only the wide cuff of the waistband. Did I make a mistake? No way! Absolutely not. Muttering to myself, I pulled the patient's arm out.

When the arm was fully exposed, I was shocked: even though the arm was thin, it was not necessary to tie a cuff with only a belt width. This cuff should be for children!

After just a few seconds, I opened the drawer of the anesthesia machine and found an adult cuff. After putting it on, I immediately pressed the blood pressure measurement button.

When the blood pressure dropped from over 140 to just over 110, we finally knew what the problem was. Fortunately, the patient's vital signs were stable. Looking back, I am a little scared: if this was an elderly and frail patient, even if the error was only 30 mmHg, it would be enough to cause a big problem.

【Knowledge Point】For accurate blood pressure measurement, you must pay attention to the choice of cuff: choose a cuff with appropriate width, generally 2/3 of the length of the upper arm. If it is too wide, the measured value will be too low, and if it is too narrow, the measured value will be too high. In addition, the tightness of the cuff should be such that one finger can be inserted. If it is too loose, the measured blood pressure will be too high, and if it is too tight, the measured blood pressure will be too low.

At this time, the intern was rubbing his hands in bewilderment.

Although he was very scared, we didn't hold back and criticized him harshly. We needed to let him know that the object of our treatment was a human being, and we couldn't afford to be careless!