Friday, May 25, 2018

Grading Pulses

A complete physical examination includes the assessment and recording of arterial pulses in all locations.  While examining the pulse, the observer should note its intensity, rate rhythm and if any blood vessel tenderness, tortuosity or nodularity exists.  It is unreliable to attempt to estimate blood pressure via arterial palpation without the use of the sphygmomanoeter.

The patient should be examined in a warm room with arrangements made so that the patient's pulses can easily be examined from both sides of the bed.  A cool environment may cause peripheral vasoconstriction and reduce the peripheral pulse.  Palpation should be done using the fingertips and intensity of the pulse graded on a scale of 0 to 4+;  with 0 indicating no palpable pulse; 1+ indicating a faint, but detectable pulse;  2+ suggesting a slightly more diminished pulse than normal;  3+ is a normal pulse ; and 4+ indicating a bounding pulse.

The student examiner must be alert to the possibility that the pulse he or she feels may be due to digital artery pulsations in his own fingertips;  this source of confusion can be eliminated by comparing the pulse in question to his own radial pulse or to the patient's cardic sounds as determined by auscultation over the precordium.  In general, it is inadvisable to use the thumb in palpating for peripheral pulses.  The thumb carries a greater likelihood of confusion with the examiner's own pulse and generally has less discriminating sensation that the fingers.  Frequently, inspection will be an id to pulse location.  The examiner course of an extremity artery,  particularly if a bright light is aimed tangentially across the surface of the skin.

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