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March 15, 1976

Neonatal and Pediatric Cardiovascular Crisis-Reply

Author Affiliations

University of Washington Seattle

JAMA. 1976;235(11):1105-1106. doi:10.1001/jama.1976.03260370015006

In Reply.—  I appreciate the kind comments by Dr Steier concerning our publication "Neonatal and Pediatric Cardiovascular Crisis." However, I cannot agree with his statement that Steinfeld et al have proved the "nonexistence of the so-called wide cuff effect." I personally have responded to a "stat page" for a child who was thought to be in shock and found that the only problem was a change in nursing personnel; the new nurse used a cuff that was too large. Also, from a theoretical point of view, physical damping will reduce energy transmitted through the system, and an excessively long cuff reduces the amplitude of transmitted waves and will, accordingly, reduce the apparent systolic blood pressure.As Steinfeld and his colleagues admit, they used a Doppler ultrasonic transducer for a pickup and suggested that poor signal pickup with a stethoscope could account for the low values previously reported with the application