Examination of pulses Flashcards
what should the right hand be used to do when feeling right radial pulse with left hand fingers
hold patients right fingers
what tendon is the radial pulse lateral to?
flexor carpi ulnaris
order of pulses
radial brachial carotid popliteal dorsalis pedis posterior tibial
where is the brachial pulse found
medial aspect of antecubital fossa
palpate biceps tendon and move medially
where is the carotid pulse found?
medial to sternocleidomastoid and lateral to larynx
do not examine once as may cause syncope
where is the popliteal pulse found
popliteal fossa
patient flexes knee
place thumbs on both sides of patella
fingers deep into popliteal fossa
where is the dorsalis pedis palpated
tarsal bones on the dorsum of the foor
where is the posterior tibial pulse palpated
1 cm behind medial malleolus
what features of pulse should be noted
rate rhythm character volume symmetry presence of bruits character of vessel wall
what does the radial pulse assess
rate
rhythm
what does the carotid pulse assess
volume and character
how is symmetry assessed
compare right and left of each pulse
left and right and radial and femoral should be in synch
rate
how fast or slow pulse is
count for 30 seconds and give as bpm
normal rate
60-100 pm
rhythm
is the pulse regular or irregular
time interval between beats
regularly irregular / irregulary irregular
what is a regular pulse described as
normal rhythm
what causes regularly irregular rhythms
abnormal rhythms of the heart eg second degree heart block
what causes irregularly irregular pulse
atrial fibrillation
pulse character
pattern in rise and fall
pulse volume
maximum rise of pulse, estimate of how much blood is pushed out of the heart with each contraction
what is character of pulse altered by
things changing eash at which blood flows from ventricle to arteries
eg aortic incompetence - valve doesnt close properly after blood leaves heart, pressure wave rises steeply and falls quickly
assessing radial pulse and elevating wrist above shoulder level , exagerrates rapid rise and fall of pulse this is called a collapsing pulse what pulse assessment is this part of
character
where may a slow rising pulse be detected
carotid
slow rising and falling pulse character in the carotid with a small volume indicates what
aortic stenosis
if the heart cannot contract/hypovolaemia what pulse volume is expected
low volume
co2 retention, anaemia and fever have what effect on pulse volume
increased pulse volume
what may asymmetry indicate
disease of the vessels
what does radio radial delay indicate
coarctation of aorta proximal to left subclavian artery /aortic aneurysm
what does a radio femoral delay indicate
coarctation of aorta
disease of vessels eg athersclerosis
how is prescence of bruits assessed
auscultation over a large vessel eg carotid artery
what are bruits
noise caused by turbulent blood flow
what do bruits indicate
arterial lumen has been narrowed by atheroma
what vessels have a more rigid feel
diseased arteries
