Clinical Skills: Pulses assessment

Hello, this video covers how to assess the various pulses in a normal examination. You do everything on this list but to keep things concise, this video will focus on the steps in blue and will also cover special populations like infants, Children and the elderly as well as a summary meet Fred.

Fred's pulse is between 60 100 BPM. The rhythm is regular and on a scale of 0 to 4, the force of Fred's pulse is a three which is normal.

But what if Fred's pulse isn't normal for starters? The rhythm could be irregular or the pulse could be too slow, fewer than 60 BPM, which is called bradycardia.

On the other hand, Fred's pulse could be too quick, more than 100 BPM which is called tachycardia. Fred's pulse might also be weak and thready.

A subjective one or two on the scale of 0 to 4 that indicates low stroke volume like hemorrhagic shock. On the flip side, Fred's pulse could be full and bounding a subjective four on the scale of 0 to 4 that could be from anxiety, heart disease or valvular conditions.

Let's take Fred's radial pulse. We could do this because we want to assess blood flow to the hands or because it's one of the most easily accessible pulse locations.

First place your first three fingers at the wrist, flexor laterally along the radius bone, press firmly to obliterate the pulse and then apply a little bit less pressure until you can clearly feel the pulse count.

The first beat you feel as zero, the second beat is one, the third beat is two and so on is the rhythm regular. If so count how many beats occur in a 32nd window and multiply by two to get the heart rate.

If the rhythm isn't regular count, the number of beats in a full minute while you count, assess the strength of Fred's pulse on a subjective scale of 0 to 4.

Now check the other wrist to assess for symmetry. Both sides are equal on Fred.

So both hands are receiving the same amount of blood flow. Now, let's take Fred's carotid pulse.

The carotid pulse is also easily accessible, but we can also use it if other pulse sites are not available. First check for obvious pulsations, then using your first two or three fingers gently palpate the left, then right artery between the larynx and the anterior border of the sternocleidomastoid muscle do not palpate both arteries at once.

That reduces blood flow to the brain. Also don't apply excessive pressure that could cause vagal stimulation.

Compare the two sides. A weak pulse might indicate cardiogenic shock.

A bounding pulse might indicate aortic regurgitation. Now, let's take Fred's apical pulse.

We would take an apical pulse when the radial pulse seems irregular or because Fred's condition requires a more accurate assessment.

This is the most reliable, noninvasive way to obtain his heart rate with your fingers, use anatomical landmarks to find Fred's apical impulse, find the bony prominence just below the suprasternal notch.

That's the angle of Lewis, move your fingers down each side of the angle to find the second intercostal space, then move your fingers down the left side of the sternum to the fifth intercostal space and move laterally to the left midclavicular line.

You may find it easier to identify the apical pulse by rolling Fred part way to the left. In cases of cardiac enlargement.

The pulse is often found lower and further to the left place. Your stethoscope against Fred's apical impulse.

When you can hear Fred's heart sounds, begin counting his heartbeat same as before. Now, that we have a rough idea of both Fred's radial and apical pulses.

We might have noticed a pulse deficit. A pulse deficit is when the apical pulse is irregular and there's a difference of more than two BPM between the radial pulse and the apical pulse.

This may indicate atrial fibrillation. Now, let's take Fred's femoral pulse.

The femoral pulse is used to assess blood flow in each leg or during physiological shock or cardiac arrest when other pulses are not palpable place your first two fingers below the inguinal ligament midway between the pubic synthesis and the anterior superior iliac spine.

An exaggerated femoral pulse is characteristic of femoral aneurysm. All right, let's take Fred's popliteal pulse too.

Flex one of Fred's legs a little. It should be relaxed, curl both hands around the knee and into the popliteal fossa, pressing deep, an exaggerated popliteal pulse is characteristic of a popliteal aneurysm.

A diminished popliteal pulse with a normal femoral pulse tells us there's an obstruction of a thigh artery which is characteristic of atherosclerosis.

Next, let's take Fred's posterior tibial pulse to assess blood flow to each foot. Tell Fred to relax and slightly extend his foot, place your fingers behind and below his ankle bone and compare both sides.

And now let's take Fred's dorsal pedis pulse to assess blood flow to each foot again. Now again, tell Fred to relax his foot, run your fingers in the groove between the extensor tendons of Fred's great toe and his first toe until you feel the pulse.

Again, compare both sides. Fred's dorsal pedis pulse may be absent for congenital reasons.

A diminished dorsal pedis pulse may indicate peripheral artery disease. If a pulse is hard to find because the patient is young or there's swelling around the limb.

A portable Doppler ultrasound can be used, apply conductive gel to the skin where the pulse is located. Then with the ultrasound on, take the sensor and place it over the pulse.

You should hear a regular whooshing sound through the ultrasound speaker. If you don't hear that whooshing sound readjust until you do find it.

Infants have fast resting heart rates right at birth, resting heart rate is between 100 and 100 and 80 BPM. After a few days, the heart rate should decrease to 100 and 20 to 100 and 40 BPM.

Heart rates will vary by quite a bit between moods. It might go up to 100 and 70 if the infant is crying or dip down to between 7090 if it's sleeping because of the fast heart rate.

The easiest way to measure heart rate in infants is by auscultating. The apical pulse.

Infants also have a heart that's more horizontal than in adults. The apical pulse should be between the fourth intercostal space just lateral to the midclavicular line.

As a child ages, their resting heart rate will decrease until it stabilizes in adulthood.