Korotkoff Sounds Annotated Video
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- เผยแพร่เมื่อ 23 ก.ย. 2024
- This is a video I made to demonstrate the Korotkoff sounds in relation to the reading on the sphygmomanometer. It was made to be used in a lecture here at the University of Sydney where the lecturer can talk the students through what is going on, hense there is no voice over, but the annotations should allow the video to stand alone.
The first part of the video is looking at the Shygmomanometer reading. At the end I have played the sounds again showing the audio recording, where you can see the various changes in the sound recorded which makes it a little bit easier to see some of the changes, eg the broad swishing sound for sound II, the loss of the swish again for sound III or the sudden drop in volume for sound IV etc
Feel free to use it if it is useful to you. Just let me know how you have used it in the comments so I can see in what ways others have found the video helpful. Thanks!
Hey I'm a nursing student and I found this very helpful. Thanks a bunch. I'm going to share with my classmates.
I will be sharing this with my students in my Introduction to Medical Careers class in my part of the presentation on vital signs. They will watch this and another video demonstrating how to take and read and hear blood pressure, then I will allow them to take each other's blood pressure. Thank you for doing this. it is very clear and the very best way to allow the student to see and hear without having to have the whole class be quiet.
What happens when your digital instruments fail for some reason (power outage, dead batteries, etc.) or are otherwise unavailable? Two is one; one is none. (In other words, always have a backup.)
how in the flying blue hell are you supposed to hear this in the back of a moving ambulance
Daniel Day takes a lot of practice. sound missing is the siren and bouncing around on bumpy roads
Yeah or a noisy ED? I don't even know how the doctors are able to hear basal rhonchis when there's a screaming patient in the next room LOL. I guess it takes tons of practice.
All nurses, and nursing students, must learn this technique. There are times when the electric ones just can't get a reading, and a physician isn't going to come down and assess a patients blood pressure every single time it needs to be checked.
that's rubbish. All health care professionals should be able to take a manual BP, machines are not reliable. in an emergency a manual BP can give you much more info!
make it easier on yourself! Inflate past the systolic blood pressure (in this case 110), when the needle drops down to the systolic you will hear the first sound (which sounds like a heartbeat). Then wait for the sound to disappear, the measurement at which the sound disappeared is the diastolic. Those two will give you SP / DP! Dont' worry about all 5 sounds.
Amazing to demonstrate without the need for equipment, to students that won't be performing the measurement but need to be familiar with the rationale behind it. Thank you !
OMG YOU ARE A LIFE👏🏾SAVE👏🏾ER👏🏾 I COULD NOT hear ANY of the sounds because my classmates were scrambling around too much, I was trying to pay attention to the instructor who would stop half-way to help another group, and I even think my stethoscope was positioned wrong because I think its closed when my instructor told me it was open. So I'll try it again and know what to expect. Thank you sooooo much!
This is the best video on youtube to teach students how to recognise and distinguish Korotkoff sounds....I am having trouble knowing which is which but this video gave me the starting point I needed...rest is practice.
Excellent video! I am a first year nursing student at CSU and this was EXTREMELY helpful - thanks again!!
CSU as in Charles Sturt University? :D That's where I'll hopefully be starting my vet program next year.
+Sandra Fowler reading your comment after 1 year makes me wanna ask you , are you doing well ? :)
joseph saber I never made it there. The 3 hour each way commute was too far and my citizenship hasn't gone through yet. It looks like I won't be able to study veterinary science at all unless I can pack up our entire lives and move closer to a university with a program. CSU is the closest to me.
+Sandra Fowler Yes sadly that is always the way. I was living in a town called Whyalla which is about 4 hours west of Adelaide, when I finished high school I got into a Bachelor of Teaching at Flinders University in Adelaide or a Bachelor of Science at Melbourne Uni. I ended up choosing science so I packed up and moved to Melbourne (which also has a great Vet course by the way), then after finishing my Science degree, I got into a PhD at Sydney Uni with a scholarship so again I packed up and moved to Sydney in order to do the course. Some times I think you just have to do that to get your degrees, then you can move to where ever you want. You are lucky with a vet degree you could live in the country which is what I would love to do!!
Look at y'all doing useful things and going to medical school. I plan on going into film😬
I'm a trainee MA and I found BP measurements with an aneroid, manual BP cuff to be an intimidating to learn part of taking vitals; this was incredibly helpful for me to conceptualize what it is we're listening for when measuring systolic and diastolic BP
Thanks @protonmonkey that is great to know. Glad you found it helpful.
Clear sounds and visual explanation congrats for your hardwork and time thank you
So simple and effective .... great demostration
Thanks. Glad you liked it.
This is PHENOMENAL ⭐⭐⭐⭐⭐ Thank you for making such a clear video with excellent descriptions 🙏
That test subject has good blood pressure levels! 110/68.
Hi from the UK. This is a fantastic video. You have publicly consented to use, but i will be using this to accompany vital signs recordings in a virtual classroom for student healthcare workers. Normally we would teach them how to listen for the sounds in class. However, due to COVID-19 this is not possible. Thank you.
You are welcome. I am glad the video is useful to you.
Hello I want to know that I got my regular and loud beat at 120/70.. But I alwz heard some sporadic sound after 180... Which is correct to measure? Regular or sporadic?
Это лучшее видео с лучшим примером прослушивания давления с использованием фонендоскопа.
I'm a bit puzzled when I'm taking my own BP what is the actual first sound. There's this very very tiny, almost undetectable beat already some 15-20 mmHG before the actual tapping sound and needle bounce.
no-one yeah i'm wondering about that same question because it concerns me mine can be heared exactly as you explained a tiny flow almost unnoticeable even some docs didnt noticed but mine can be heared 30 to even 40 before the actual flow
I know what you mean. This is actually blood seeping past the cuff pressure. It could have to do with the wrong size cuff being used.
..mine sounds nothing like a 'tap' .
It was like cooking pots banging each other.
And thats 140
The sound stops at 100
So i know my bp is 140 /100
Que vídeo perfeito, justamente isso que procurei, aferir e ouvir, esses vídeos gringos são os melhores vai me ajudar bastante 👏👏
So some texts/references say the 4th korotkoff sound is a more accurate measurement of the diastolic blood pressure..in this example the two numbers and clinical interpretation would be significantly different; you placed 4th at 88-90 mmHg which is borderline stage 2 hypertension vs the 5th korotkoff sound which was normal. Any help?
Good question. There has been consideration of which Korotkoff sound K4 or K5 should be used for the determination of diastolic pressure since the 1930’s. It is the current US standard of measurement of diastolic blood pressure to take K5 as diastolic pressure (www.ahajournals.org/doi/10.1161/01.hyp.21.4.504?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed)
So by definition K5 is diastolic blood pressure when measuring blood pressure by auscultation. It should be noted that both K4 and K5 when measuring by auscultation correlate with diastolic blood pressure measured by central canula, though correlation is higher for K5 (0.83 for K4 vs 0.93 for K5). Interestingly on average K4 diastolic blood pressure is 5.3mm above the value measured centrally while the K5 difference was 13.1mm above central measurements but variance is greater when using K4 (SD for K4 was 13.9 vs K5 9.5). In other words using K5 was more reliable than using K4 as a measure of Diastolic BP (www.ncbi.nlm.nih.gov/pmc/articles/PMC1817226/). It has been noted more recently that K4 was undetected in 36% of observations and K5 was undetected in 2% of observations (pubmed.ncbi.nlm.nih.gov/9653859/), probably resulting in the greater variance of the earlier studies.
The current recommendation by the American Heart Association (AHA) when taking blood pressure by auscultation is also to use K5, except in situations in which the disappearance of the korotkoff sounds can not be reliably detected eg in pregnant women (onlinelibrary.wiley.com/doi/full/10.1111/j.1524-6175.2005.04377.x) or in children, though this recommendation changes regularly (www.ncbi.nlm.nih.gov/pmc/articles/PMC4288115/).
So to answer your question, I wouldn't say K4 is a more accurate measurement, it is on average closer to the centrally measured value but because K4 is more difficult to detect even by trained practitioners the value tends to be more variable, and therefore is NOT more accurate. K5 is the most accurate and reliable measure for determining diastolic pressure by auscultation in normal adults.
@@AusFastLife Thank you so much! I really appreciate your thorough response.
Hi there Haydn!
Is it possible to incorporate the audio of Korotkoff sounds from your video to our virtual reality simulation for VR headsets, where one of the thing we will be teaching is how to use a blood pressure monitor? We would fully credit you in the simulation. Please, let me know.
Hi Michael, yes sure that would be fine. In the credit do give a link back to this video. And if you wouldn't mind, could you let me know the name of the product that it was used in and the publisher. I make a note of where my publications are cited including this video. Thanks.
Hello, I'm making a nursing simulation for VR for students in South Korea. Nothing speaks korotkoff more accurately than the sounds in this video. Is it okay if I use the sound from this video for a simulation? It will be used for about 3 minutes.
Hi @user-qo9wr5do4j - yes that would be fine for you to use the audio from tis video in your VR nursing simulation. Thanks for letting me know.
EXCELLENT. The best I have heard so far.
Great video!! Now I finally understand them
I really wanna know how do you record the sound from the stethoscope where should I place my mic so I can record the korotkoff sound
I was using an electronic stethoscope to record this. It had a 3.5mm headphone jack which I was able to plug into the mic port of the sound card on my computer. I then recorded the audio directly into my recording software (Adobe Audition). But I have also amplified heart sounds by cutting off the head of a stethoscope leaving enough tube to insert the head of a lavalier microphone. The microphone will then pick up the sound from the head of the stethoscope just as your ears would have if the sound had been funnelled by the tubing up to the ear pieces. You can then record the microphone output.
Hadyn, may I use your video for a demonstration speech I am giving on vital signs for my speech class?
Of course. Please feel free.
Very helpful video. I will share this with my assisting students. Thanks.
This is excellent. Just a note that I think they are Korotkoff sounds after Dr Nikolai Korotkoff who apparently discovered them.
extremely helpful video .. thank u soooo much for help .. thank u so much once again.
Really well made video, the content is very clear and well explained. Used this at an introductory lecture to biomedical engineering LBM1011
Appreciable piece of work. thanks for sharing.
So their BP would be 110/68?
Yes that's right.
that would be hypotension. correct?
Joy No, that can be a perfectly normal BP. Hypotension is a systolic number less than 90mmHg and diastolic 60mmHg.
I heard 72 not 68
@@marcosbinda639 omg same i didnt hear the 68
What are the sounds in the midle, after the high and before the low. Do they mean anything? Thanks
+Aldo Naser Sorry I am not sure what you mean. There are a series of sounds in the recording, there are the actual Krotkoff sounds, and the whirr of the computer fan when I was shooting the video...
Guess he means sounds 2,3 and 4.
how in the hell are you suposed to detect these tiny sounds in the middle of a moving ambulance or in a noisy hospital
With a stethoscope...
Most hospitals now use automated blood pressure monitors based on the original von recklinghausen oscillotonometer which is basically this but replace the stethoscope with a strain gauge in a second cuff . Modern ones also just use one cuff. We still use stethoscopes and Mercury sphygmomanometers when accurate and precise measurements are needed for example in clinics and clinical trials. Good question
Very helpful video. I would like to use it in my Clinical Practice course, teaching PA students how to take blood pressures.
Hi Ronda, please feel free. Thanks for letting me know.
Hi this was very helpful for a lesson plan that I am designing as a capstone project in the nursing BSN program. I would like to cite the work; what information can I use for the citation? Thank you
Hi Rochelle, thanks, you could use the citation (Allbutt, HN. 2014 th-cam.com/video/VJrLHePNDQ4/w-d-xo.html; retrieved 23/7/2019 - or appropriate date for you)
thank you for this! My immersion is near and I need to prepare myself for that
Thank you for always there for us, just keep in touch and stay connected my dear friend, keep safe always.
So the sound II is the real beginning of the systolic ??... Thanks
Used as part of a final year Biomedical Sciences project on hypertension - Thank you!
Thanks this really helped me a lot !!
Most helpful video yet! Thank you so much!
I want to know onething that should anyone consider the hard sound after releasing the air from machine of heart of the one consider as sounds starts after releasing the Air. This is only my confusion. I'm not professional but I've this spygnometer at home for BP checkup
Should the bp apparatus be at the level of heart like the cuff tied and heart.... It it doesn't have any effect???
Yes definitely. Columns of liquid exert pressure onto the sides of the tubes that contain them, so if you were measuring the hydrostatic pressure of blood in your blood vessles at a level that was higher than your heart then the hydrostatic pressure will be slightly less than what your heart is experiencing, while if you measued the hydrostatic pressure at the level of your legs you would find the pressure would be higher than at heart level, since there is a greater column of blood above that point also exerting pressure on the vessle walls. By recording blood pressure at the same height as your heart the hydrostatic pressure will be the same and the only pressure changes you will measure will be due to the heart pumping and the elastic recoil of the blood vessles, ie systolic and diastolic pressure, which is exactly what you are trying to measure.
I am a midwifery student in New Zealand and have used your video as part of an educational resource for Korotkoff sounds, I have linked your video to the poster I have made via a QR code. Thanks for this video!
Lovely, Thanks Mara. I am glad it was helpful.
Is the dial always supposed to be released that slow? Mine keeps going fast
It is a good idea if you do release the pressure slowly as you are after the pressure when the sounds first appear and later disappear. If you are going too fast then it will be unclear exactly what pressure corresponded to the change in the sounds. With practice of course you get faster, and I was going very slowly so we can see the start and stop of the sounds on the video.
I must correct you it was at 62. It demonstrates one of the problems with this method. You can only measure as well as you can hear.
We would like to use this in our upcoming publication. Is there any way we can get in touch?
abacindy95@gmail.com please contact me for more information. Thank you
Many thanks for the video! Very helpful!
Not only sounds U can also watch the hands of the dial start to beat back and forth with the sound at first sound.. even if U dont hear the sound U can look and tell when the beat starts..
I'm so grateful for this video 😍!, Thank you
You're welcome!
This is very very helpful
Thanks so much for this!
I’ve just happened to find this while googling for Korotkoff sound. I’m making a short video clip on how to measure BP and would like to use a part of your video. Thank you for uploading such useful content. If you want us to make citation just let me know by a comment.
I couldn't hear the heartbeat. Since I'm doing externship in a busy doctors office, since it's hard to hear the beat you can tell by the needle, once tick for the top number, and it ticks twice for the bottom number.
very good....i need some more this video
really useful thanks for uploading this
thank you. this is very helpful.
Thanks for this video! It's so useful ;)
Thank you for this video!!!!! I did not understand how my book explained the phases. Great job!!
You're welcome. I am glad it helped. Yes I much prefer to see things and hear things working than read about them. It is much clearer that way I think.
Great video and thank you for sharing it.
You are very welcome!
Used this in lecture/lab at Lindenwood University, St Charles, Missouri. Thanks!
Thank you! this is helpful for learning.
Thanks for sharing this with us
Great vedio, thanks.
Every small line equals 2 , no odd numbers, dont make up numbers not in the scale ' just learned that " 👌🏻 good luck
Is that the convention in clinical practice? In science when reading an analogue scale the rule is that the smallest number you can read off a dial is the number represented by half way between two of the smallest divisions. In the sphygmomanometer in this video as you say the smallest division is two mmHg, so the smallest value you can read is half way between which of course is one.
Make things clear!! YOU ARE AWSOME
I became always confussed about getting the reading of diastolic as I listened the beat till the end
very helpful, thanks!
Thank you, the videos I had for this did not help me understand what I was listening for.
thank you 🙏❤
Thanks for sharing this!
Nice video❤
Wow excellent video
110/76 mm Hg.
Wouldn't it be 68?
Thank you very much
Fabulous ! Thank you !
What will I do if My blood pressure is just 80%?
Why cant I hear under 78?
110/70
1:05 -1
1:13 -2
1:19 -3
1:22 -4
1:33 -5
Lovely!
EXCELLENT VIDEO PRESENTATION. DID YOU EXAMINE A PATIENT WITH BP 180/ 90 AND ANALYSE THE SOUND ?? THANKS.
No, one of the lecturers here at the University of Sydney just needed a recording of normal heart sounds for a lecture they were giving, so I recorded my own. We are lecturers and research scientists, not clinicians so we don't have access to patients with pathological conditions.
awsm! Use earphone for better perception
I got 110/70
that last thud was not loud lol
That's how it's supposed to be, NOT LOL
Excelente!
Thanks!!! This me a lot
Awesome!
Presumably the cuff would have to apply more force on a big muscular arm than on a thin flabby arm. That means you'd measure a different reading on different people even if their blood pressure is the same. And even using the same cuff on the same arm you always get different results. It's a very crude, unreliable test in my opinion.
Hi @Tin Man. No not at all. Your arm is full of liquid and liquid is nocompressible. So when you apply pressure to an arm, that pressure is transmitted to the contents of that arm equally, it doesn't matter whether you are thin and scrawny or huge and muscular. If blood is being forced around your arteries by the heart at 120mmHg, then it will take at least 120mmHg of pressure in order to occlude those arteries and stop the flow of blood. On the other hand if you apply less than 120mmHg of pressure, since the heart is applying 120mmHg of pressure in this example, the force will be able to overcome the sub maximal occlusion and blood will flow past the cuff. So you are measuring the amount of force necessary to completely occlude the brachial artery. That point where there is just enough pressure to block the artery is by definition systolic pressure.
So no you are measuring exactly the same point on different people. If their systolic blood pressure is 120mmHg you will need to apply 120mmHg of pressure in order to occlude the artery. It is just fluid dynamics. In the hands of a skilled operator manual auscultation will reliably measure systolic and diastoloic pressure repeatably. If the person is less experienced at measuring blood pressure it is true that they may miss the sounds and so come up with a blood pressure that wouldn't compare as well with say an arterial cannula, but in the hands of an experienced operator that generally isn't a problem. Lastly this method of measuring blood pressure is far from being crude and unreliable. You use this method to verify automatic sphygmomanometers if you suspect they may be unreliable. Arterial cannulas are more accurate, and provide a continuous reading of blood pressure but it is a very invasive method that can cause bleeding or blood clots, bruising and it hurts. You really only use arterial cannulas if you have to.
@@AusFastLife » Let's say I want to squeeze off the flow in a garden hose. It takes more force if the hose is stiff or thick walled, less force if it's flexible and thin walled. If I put a BP cuff on the hose I'd expect a different readings from the stiff vs flexible hose the even though the fluid flow and pressure is the same. Is that not a good analogy?
@@tinman1955 Yes, but we are not talking about two different types of hose. The structure of the blood vessels in both arms are the same even if one arm is bigger and more buff than the other in your example. So with an internal blood pressure inside the blood vessels of 120mmHg (again just to pick a pressure, but obviously different people have different blood pressures) it would take at least 120mmHg of pressure from the outside to squeeze the vessel shut and to keep it shut against the 120mmHg being generated by the ventricle of the heart. I think what you are assuming is that the surrounding muscle would have some sort of supporting effect on the vessels such that a portion of the pressure exerted by the cuff would be taken up by the skeletal muscle of the arm and not transmitted to the blood vessel, so if one person had big muscular arms then it would take a greater pressure due to the presence of the extra muscle to compress the arm sufficiently that the blood vessels are also compressed, but that is not how fluid dynamics works. Your cells are just sacks of water. Skeletal muscle cells do have contractile proteins in them in order to make the muscle cells shorter when you contract a muscle, but all that is doing is bringing the ends of each cell, and thereby the muscle, closer together. The cells themselves are still just fluid filled sacks of water.
If you take a volume of water, e.g. a glass of water, and insert a piston and press on that piston with a certain force, because water is not compressible it will not change volume. Instead all parts of that volume of water will now have the pressure that you are exerting by pushing on the piston. If you had a bunch of muscle cells in that glass of water, they would experience the pressure you are exerting, yes that is true, but the blood vessel would also experience that same pressure. You could flex your arm muscles and that will mess up the pressure reading of the sphygmomanometer since the muscles are pushing back on the cuff but that is not what we are talking about. If you measure the blood pressure of bodybuilders and compare that with the blood pressure of age matched non-bodybuilders you will find that there is no difference in blood pressure (e.g. www.ncbi.nlm.nih.gov/pubmed/3359358).
Too good!!
Good Day Dr. Allbutt! Your video is very helpful! Can I ask permission to download your video for my online curriculum material? I will cite you including your credentials as a doctor
Hi Rolando. Yes sure, that is fine. You are welcome to download the video (here is a link if that is easier www.dropbox.com/s/gxy30kjaw4ivcp6/Krotkoff%20Sounds%20Annotated%20Video.mov?dl=0), but if you could also include a link back to this you tube video with the citation in your online material, that would be great. I am glad you found the video useful.
Thank you very much Doctor Allbutt! By the way is it okay that the reading would at least fall within + or -
2 mm Hg from the actual reading as sometimes there are discrepancies ?
Hi Rolando. Yes +/- 2mmHg is negligible physiologically. Just look at the range of normal. 120/80 is the text book normal but for a teenager systolic is normal if it lies within 105-135mmHg while diastolic is normal if it lies within 60-86mmHg. As you age, what is considered normal also changes, for a 50 year old, systolic pressure in the range of 115-160 is considered normal (JAMA. 1950;143(17):1464-1470). As you can see if you were 18 years old and had a reading of 110/72 but your actual blood pressure was 112/70 then that would be fine. Small variations of 2mmHg in blood pressure are meaningless. Your blood pressure changes more than that multiple times during the course of a day. Going from laying down to standing changes blood pressure from 153mmHg systolic laying down to 147mmHg systolic standing for 63 year old subjects (www.researchgate.net/profile/Yuhei_Kawano/publication/8112896/figure/tbl1/AS:601588318085166@1520441240816/Systolic-blood-pressure-diastolic-blood-pressure-and-heart-rate-in-supine-and-standing.png). In another study looking at elderly subjects, before eating the blood pressure of normal patients was 132/74 after eating in the same subjects 128/76 (www.jfcmonline.com/viewimage.asp?img=JFamCommunityMed_2012_19_1_20_94007_b3.jpg). So just eating was enough to drop systolic by 4mmHg
What i mean is the accuracy of the reading if it is 2 mm more or less than the actual. So in your video if someone has a reading of 108/ 68 instead of 110/68 is it still okay?
In that case I don't understand your question as that is what I answered in my previous response. My answer would still be the same. 2mmHg has no physiological effect so it would make no difference if you read 108/68 but the person actually had a blood pressure of 110/68. Could you express the question in a different way if that is not what you are asking?
thank you so much
Thank You!!!😃
I love it❤️❤️❤️
Please which number correspond to the diastol ?
68mmHg. Diastole is the point at which the tapping sounds stop. The last sound was heard as the pressure in the cuff dropped to 68mmHg, so therefore we say that Diastole is 68mmHg.
Thank you
Nice
Amasing!!
how did you record the sound
I had an electronic stethoscope which had an ear phones port. I fed the audio out into my computer and recorded with cool edit pro (but any audio recording software would have done the trick)
i couldn't hear sounds
should record true DBP or clinical DBP?