Pulsus Paradoxus How to Quick Guide - Stanford Cardiologist's

Note: This is a shorter clip from a longer Stanford 25 teaching session on pulsus paradoxus. For full context, including the complete pathophysiology discussion and live Q&A, watch the full-length video here:    • Pulsus Paradoxus Physical Exam - Stanford ...   In this Stanford 25 session, Dr. Ronald Witteles, Professor of Cardiovascular Medicine and Program Director for the Stanford Internal Medicine Residency, demonstrates how to measure pulsus paradoxus at the bedside. Filmed live during Stanford Internal Medicine Morning Report, this hands-on teaching segment walks through the key principles, step-by-step technique, and common pitfalls of this important physical exam skill. You’ll learn how to identify the two key blood pressure measurements that define pulsus paradoxus, why it occurs, when this bedside maneuver works best, and how it correlates with invasive hemodynamic monitoring and echocardiography. Dr. Witteles also shares practical pearls for detecting the finding in real-world clinical situations, and explains its role in diagnosing cardiac tamponade and other conditions. Chapters 0:00 Creating pulsus paradoxus for demonstration 0:19 Why we’re using blood pressure cuffs 0:38 Understanding the pressure-time curve 0:44 Identifying the two key blood pressure numbers 1:05 Step-by-step BP cuff technique 1:16 Recognizing the first Korotkoff sounds 1:23 Why sounds differ during inspiration vs expiration 1:41 Understanding the true breathing pattern effect 1:57 How to interpret differences in loudness of sounds 2:17 Recording the first measurement 2:24 Going slowly to reach the second measurement 2:27 Confirming constant sounds every heartbeat 2:37 The #1 mistake when measuring pulsus paradoxus 2:56 Ignore the patient’s breathing, just go slowly 3:14 Adjusting cuff pressure correctly 3:36 Using A-line or pulse oximeter as alternatives 3:52 Recognizing limitations with irregular rhythms 4:27 Why you might skip echo if you can measure pulsus paradoxus well 4:58 Clinical relevance in pericardial effusion and tamponade