Physical examination maneuver
Pulsus Paradoxus
How to Perform
Choose an appropriately-sized blood pressure cuff and wrap it around the upper arm with the artery marker centered over the brachial artery. Place the stethoscope in your ears, palpate the brachial or radial pulse while inflating the cuff, and inflate to about 30 mmHg above the point where the pulse disappears. Place the stethoscope over the brachial artery and deflate the cuff very slowly until the repetitive tapping sounds (Korotkoff sounds) become audible only during expiration and disappear during inspiration; note that pressure. Then continue to deflate the cuff slowly and note the pressure at which Korotkoff sounds become audible during both inspiration and expiration. Pulsus paradoxus is present if the difference between the two pressures is greater than 10 mmHg.