This is how you use a sphygmomanometer and get your blood pressure manually. Wrap the cuff 1 inch above the elbow. Place your stethoscope below the tub which is running at the inside of your arm. Close the valve and pump air up to 30 mmhg above the palpated systolic pressure. Slowly open the valve. The first sound with a tick or bounce is the top reading and the last sound with bounce is the bottom reading.