Dr SHAMIM ASIM Lecturer Physiology SMC, JSMU To Examine Peripheral Pulses. Human subject, examination couch, stop watch A pulse is a wave imparted by the contraction of left ventricle to the blood column. OR Arterial Pulse is defined as the Rhythmic expansion and collapse of arteries, produced by the pressure variations at the root of Aorta. 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 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. 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. 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. 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). 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. Pulsus Bisferiens: two systolic beats are palpable in one pulse. Seen in combined Aortic Stenosis and Regurgitation. Pulsus Alternans: a strong beat alternates with a weak one. This type of pulse is seen in Left ventricular failure. 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. 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. 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. 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. FEMORAL PULSE: Press with the thumb/ finger halfway between the anterior superior iliac spine and the pubic tubercle along inguinal ligament. POPLITEAL PULSE: A difficult artery to palpate. Flex the knee at angle of 120° and push fingers of both hands into the popliteal fossa. DORSALIS PEDIS PULSE: Palpate in the proximal part of the first intermetatarsal space. POSTERIOR TIBIAL PULSE: Palpate behind the medial malleolus. Radial pulse is examined. Rate is _________ beats per minute. Rhythm is _______(regular/ irregular) Pulse should be taken for one minute. Both the carotids should not be palpated simultaneously.