Hello this video covers how to assess the various pulses, in a normal examination
You'd 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 sixty and a hundred beats per minute
The rhythm is regular and on a scale of zero to four 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 beats per minute
Which is called bradycardia
On the other hand, Fred's pulse could be too quick, more than a hundred beats per minute, which is called tachycardia
Fred's pulse might also be weak and thready
a subjective one or two on the scale of zero to four. 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 zero to four
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 30-second 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 zero to four
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 interior 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
Non-invasive 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 Louis, 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 partway 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 beats per minute 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 symphysis and the anterior superior iliac spine
an exaggerated femoral pulse is characteristic of Femoral Aneurysm. Alright, 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 pedal's 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 pedal's pulse may be absent for congenital reasons
a diminished dorsal pedal's 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 a hundred and a hundred and eighty beats per minute
After a few days the heart rate should decrease to a hundred and twenty to 140 beats per minute
Heart rates will vary by quite a bit between moods
It might go up to a hundred and seventy if the infant is crying or dip down to between seventy and ninety 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
Thanks for watching
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