Diseases of the chest and the principles of physical diagnosis . ericarditis. Respiratory traction resulting from mediastinaladhesions, is brought to bear on some of the large vessels. (It may be a unilateralphenomenon.) If enfeeblement or disappearance occurs during expiration it iscalled Riegels pulse. The paradoxical pulse has little if any pathologic pathological paradoxic pulse is generally assumed to be due to constriction ofsome of the large vessels by mediastinal adhesions. The paradoxic venous pulse—•filling of the veins during inspiration—has a similar genesis. CHAPT
Diseases of the chest and the principles of physical diagnosis . ericarditis. Respiratory traction resulting from mediastinaladhesions, is brought to bear on some of the large vessels. (It may be a unilateralphenomenon.) If enfeeblement or disappearance occurs during expiration it iscalled Riegels pulse. The paradoxical pulse has little if any pathologic pathological paradoxic pulse is generally assumed to be due to constriction ofsome of the large vessels by mediastinal adhesions. The paradoxic venous pulse—•filling of the veins during inspiration—has a similar genesis. CHAPTER XIV INSTRUMENTAL METHODS, BLOOD-PRESSURE ESTIMATION Pulse tension or blood-pressure is best estimated by means of amercurial sphygmomanometer equipped with a cuff, not less than 12 width. For children smaller sizes may be employed. TECHNIC The Systolic Pressure.—The cuff is applied snugly to the upper armand secured by means of straps or a bandage. The cuff is then connectedwith the manometer and quickly inflated to a point well above the sys-. FiG. 132.—The Uskoff sphygmotonograph. folic pressure, after which the stop-cock is turned, so as to exclude thepump from communication with the cuff. A stethoscope is now placedover the brachial artery below but not in contact with the cuff, and auscul-tation is practised while the pressure is gradually allowed to fall. Thefirst clear thumping or pounding noise indicates the fact that pressure inthe artery is now sufficiently high to force the blood under the constrictingcuff, and to distend the artery below. The height of the mercurial 163 164 THE EXAMINATION OF CIRCULATORY SYSTEM column at which this acoustic phenomenon occurs indicates the systolicpressure in the brachial artery. The Diastolic Pressure.—The examiner should continue to listenwhile the mercury falls, and in doing so will notice after a time, that thethumping sound is followed by a hiss or murmur which in turn dis-appears and is replaced by a clear-
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