Dr SHAMIM ASIM
Lecturer Physiology
SMC, JSMU
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To Examine Peripheral Pulses.
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Human subject, examination couch, stop
watch
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A pulse is a wave imparted by the contraction
of left ventricle to the blood column.
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OR
Arterial Pulse is defined as the Rhythmic
expansion and collapse of arteries, produced
by the pressure variations at the root of
Aorta.
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1.
2.
3.
4.
Introduction
Informed consent
Exposure of the
artery to be
examined.
Determination of
rate, rhythm,
volume, tension,
character
1.
2.
3.
4.
5.
6.
7.
Radial pulse
Brachial pulse
Carotid pulse
Femoral pulse
Popliteal pulse
Dorsalis pedis pulse
Poserior tibial pulse
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Most commonly examined pulse because:
It is conveniently accessible as it is located in
an exposed part of the body.
It lies over the hard surface of the lower end
of the radius.
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Forearm should be
slightly flexed and
semi pronated.
Keep index, middle
and ring finger over
the distal end of
radius.
Palpate the radial
pulse and note
down the following
characteristics.

Count the rate for one minute. Normal pulse
rate in an adult is about 60-80 beats per
minute.
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Examine whether the time interval between
two beats is equal or not. Normally the
interval is equal and the pulse is called
regular in nature.
If the pulse is irregular, note whether the
irregularity has a recurring pattern or not.

During inspiration
pulse becomes
rapid and during
expiration it
becomes slow. This
phenomenon is
called sinus
arrythmia.
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
This is the amplitude of the pulse wave and is
determined by the amount of displacement of
the palpating fingers.
Pulse could be of normal volume (learnt with
experience), high volume (fever) or low
volume (hypovolemic shock).
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In certain diseases the
pulse wave has a
specific wave form or
character like:
COLLAPSING PULSE
(waterhammer pulse):
high volume pulse with
normal upstroke and
rapid downstroke.
Occurs in Aortic
regurgitation,
ventricular septal
defect etc.
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Pulsus Bisferiens:
two systolic beats
are palpable in one
pulse. Seen in
combined Aortic
Stenosis and
Regurgitation.
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Pulsus Alternans: a strong beat alternates
with a weak one. This type of pulse is seen in
Left ventricular failure.
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FEEL THE radial pulse with three fingers. Press
with the proximal finger so that the pulse is
occluded and feel the vessel wall with the
middle finger.
Normally it is not palpable. In advanced
atherosclerosis it can be felt as a cord
between finger and underlying bone.
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PALPATE PULSES of both sides and compare
them.
Never palpate both the carotids
simultaneously.
RADIOFEMORAL DELAY: femoral pulse is weak
and delayed as compared to radial pulse. This
condition occurs in coarctation of aorta.
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BRACHIAL PULSE:
Flex the patient’s
arm and feel for the
tendon of biceps.
Press on its medial
side with the thumb
of your opposite
hand.
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CAROTID PULSE:
Place the thumb or
fingers of your
opposite hand along
the anterior border of
sternocleidomastoid,
at the level of
laryngeal cartilage
and press backwards.
Palpate the right
carotid from the right
side and left carotid
from the left side.
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FEMORAL PULSE:
Press with the thumb/ finger halfway between
the anterior superior iliac spine and the pubic
tubercle along inguinal ligament.
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POPLITEAL PULSE:
A difficult artery to
palpate.
Flex the knee at
angle of 120° and
push fingers of
both hands into the
popliteal fossa.
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DORSALIS PEDIS
PULSE:
Palpate in the
proximal part of the
first intermetatarsal
space.
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POSTERIOR TIBIAL
PULSE:
Palpate behind the
medial malleolus.
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Radial pulse is examined.
Rate is _________ beats per minute.
Rhythm is _______(regular/ irregular)
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Pulse should be taken for one minute.
Both the carotids should not be palpated
simultaneously.