Arterial PulseArterial Pulse

What do u understand by term What do u understand by term PULSEPULSE??

The alternate expansion and recoil of elastic arteries after each systole of the left ventricle creating a traveling pressure wave that is called the PULSE.

Reading the Reading the PULSEPULSE

Pulses are manually palpated with Pulses are manually palpated with fingers. fingers.

Two or three fingers should be used.Two or three fingers should be used.Fingers must be placed near an artery Fingers must be placed near an artery

and pressed gently against a firm and pressed gently against a firm structure, usually a structure, usually a bonebone, in order to feel , in order to feel the pulse. the pulse.

Common pulse sitesCommon pulse sitesRadial PulseRadial Pulse

Lateral aspect of the lower forearm just proximal to the wrist joint

Feel the bony prominence

Move fingertips medially

Tips of fingers drop into a groove in which lies the artery

Examine the pulse by compressing the artery backwards against the bone, using the finger tips

The brachial pulseThe brachial pulse

Medial aspect of the antecubital fossa at the line of the elbow joint.

The artery is felt by compressing backwards with fingers or thumb through the aponeuosis

Divides just below elbow to form radial and ulnararteries

Carotid pulseCarotid pulse

1-1.5 cm lateral of the midline in the neck at the upper level of the thyroid cartilage

Readily palpable at anterior border of sternomastoid muscle

May be felt with finger tips or thumb which are used to push posteriorly

Femoral arteryFemoral artery

The femoral artery enters the upper leg by passing under the inguinal ligament.

It enters the leg at the mid-inguinal point.

The femoral artery is usually easily palpated and is an important point of access to the arterial system.

Popliteal arteryPopliteal arteryThe popliteal artery is palpable in the popliteal fossa.

The artery passes through the fossa slightly medially to laterally.

The poplitealartery can be palpated in about the midline of the fossa at the level of the femoral condlyes.

Artery best felt with knee in slight flexion.

Tibialis posterior arteryTibialis posterior artery

The tibialisposterior artery is found on the medial aspect of the ankle.

It is palpable at a position midway between the prominence of the medial malleolus and the prominence of the calcaneus.

Dorsalis pedis arteryDorsalis pedis artery

Dorsalis pedisis a continuation of the tibialis anterior.

Tibialis anterior is often palpable at the ankle joint in a mid-malleolar position, medial to the extensor hallucis longus tendon.

Describing the pulse

The pulse is described by

RateRate

RhythmRhythm

VolumeVolume

Synchronous with other pulse or not (Radio-femoral delay).

State of the vessel wallState of the vessel wall

RateRate

The rate of the pulse is recorded in beats per minute. The rate should be counted over a minimum of thirty seconds.

The normal resting pulse rate is 72/min.

Abnormal slow (bradycardia)<60/min

Abnormal fast (tachycardia) >100/min

Rhythm

The rhythm of the pulse is described as regular or irregular.

If irregular the rhythm is described as – regularly irregular (a recurring pattern of

irregularity) – irregularly irregular (no discernible pattern

to the occurrence Of the irregularity

Volume Volume

The volume of the pulse is a crude indicator The volume of the pulse is a crude indicator of the stroke volume of the heart (the amount of the stroke volume of the heart (the amount of blood ejected by the heart)of blood ejected by the heart)

It is increased in exercise (full or bounding) It is increased in exercise (full or bounding) and reduced in states of low blood volume and reduced in states of low blood volume (weak or thready)(weak or thready)

State of the vessel wallState of the vessel wall

The normal arterial wall is compressible The normal arterial wall is compressible and has an elastic feeland has an elastic feel

Diseased arteries may feel inelastic and Diseased arteries may feel inelastic and even hard in cases of calcificationeven hard in cases of calcification

Heart SoundsHeart Sounds

Today’s LabToday’s LabBy the end of this practical the student should By the end of this practical the student should

be able to:be able to:

To locate all peripheral palpable pulsesTo locate all peripheral palpable pulses

Examine the radial pulse and comment on Examine the radial pulse and comment on pulse rate, rhythm, volume and condition pulse rate, rhythm, volume and condition of vessel wall.of vessel wall.

Demonstrate the effect of exercise on Demonstrate the effect of exercise on pulse rate.pulse rate.

Auscultate for heart soundsAuscultate for heart sounds

1.1. Have your partner sit quietly, remaining as Have your partner sit quietly, remaining as relaxed as possible.relaxed as possible.

2.2. Locate the radial pulse Locate the radial pulse 3.3. Record the characteristics of the pulse. Record the characteristics of the pulse. 4.4. Auscultate for the two heart sounds on your Auscultate for the two heart sounds on your

partner chest in various areas. partner chest in various areas. 5.5. Repeat the procedure and determine the pulse Repeat the procedure and determine the pulse

rate and auscultate for heart sounds in each of rate and auscultate for heart sounds in each of the following conditions:the following conditions:

a.a. Immediately after one minute of exercise Immediately after one minute of exercise b.b. Immediately after 2 minutes of exerciseImmediately after 2 minutes of exercisec.c. Immediately after 3 minutes of exerciseImmediately after 3 minutes of exercised.d. 3-5 minutes after exercise has ended.3-5 minutes after exercise has ended.

1.1. Switch partners and repeat steps Switch partners and repeat steps

2.2. Tabulate and graph your results and Tabulate and graph your results and calculate the average pulse of your calculate the average pulse of your groupgroup

Student name Pulse Rte (beats/minute)

At Rest 1 min exercise

2 minute exercise

3 minutes exercise

Group's average pulse

Discussion QuestionsDiscussion Questions

1.1. Was your pulse higher or lower than your group's Was your pulse higher or lower than your group's average? Suggest reasons for this.average? Suggest reasons for this.

2.2. Why can the heart beat be detected as a pulse? Why can the heart beat be detected as a pulse? 3.3. Would wrist or neck pulse be felt first following a heart Would wrist or neck pulse be felt first following a heart

beat? Why?beat? Why?4.4. If an accident victim had a severed left subclavian artery, If an accident victim had a severed left subclavian artery,

which pulse (neck or wrist) would be most affected? Why? which pulse (neck or wrist) would be most affected? Why? 5.5. Did you see a difference in your heart rate before and Did you see a difference in your heart rate before and

after exercise? Why does this happen?after exercise? Why does this happen?6.6. Did the sound of your heartbeat change after exercise? Did the sound of your heartbeat change after exercise?

Describe what differences you heard?Describe what differences you heard?7.7. What causes the characteristic heart sounds? What causes the characteristic heart sounds? 8.8. What is pulse deficit and what conditions might cause What is pulse deficit and what conditions might cause

this?this?