Clinical Examination of Pulse

 

Clinical Examination of Pulse

                Pulse is a periodic uplift felt over artery. This is produced by sudden flow of blood into the aorta during each systole, giving to rise increase of pressure and arterial distension transmitted from one segment of an artery to the next in the from of wave.

                The pulse gives information regarding the conditions of the vessel wall and the amount and variation of pressure of the contained blood, Also pulse gives valuable information regarding state of the heart circulation and general condition of patient.

                The pulse can be examined of different arteries-radial brachial, axellaxy femoral, popliteal; dorsalis paedis, superficial temporal etc.

 

1) MEIITOD: Commonly radial eartery is used for examination of pulse, because it is very convenient for palpation. Radial pulse is best felt at the lower lateral border of fore-arm near the wrist joint when the patient forearm is pronted and wrist slightly flexed Examine the pulse for 3 minutes to get information about pulse, as below.

 

2) RATE: Rate means number of beats minute Normal average pulse is 72/mt. but in children it is more rapid as 90 to 110/mm and in old age may become slow (55 to 65) per mm examine pulse rate when patient feels comfortable and not nervous. Because nervousness will increase the pulse rate.

 

3) RHYTHM: Normal pulse wave succeed one another at regular interval, and decreases during expiration. This physiological irregularity in pulse is called as Sinus arrhythmia.

                If pulse is irregular occasionally with definite interval then, it is called as irregularly regular. If irregularity is all the time, then it is irregularly irregular.

 

4) Volume: It is the uplift of vessel wall during passage of pulse wave. Normal pulse is of is moderate volume.

                High volume pulse is felt in hyperdynamic circulatory state.

                Low volume pulse is felt in peripheral shock.

 

5) Character: It is not usually possible to detect the wave of normal pulse or Slight variation from the normal but in certain diseases the character of the pulse is detectable abnormal. The most important of these are-Anacrotic pulse Collapsing (Water-hammer) pulse, bisferiens pulse, pulseus paradoxus, pulses alterrians.

                Collapsing (Water - hammer) pulse: Feel the pulse by grasping the subjects fore arm with the palm and then subject’s forearm is elevated above the subjects had level. By this procedure the pulse is felt easily and it is full bounding.

 

6) Conditions of Vessel Wall: Fell the radial pulse of subject with right three fingers and simultaneously brachial artery is felt left three fingers in cubital fossa. Now exert the pressure over brachial arterly by the left three fingers till no pulse in radial artery is felt by right three fingers. Now role the radial artery against underlying bone to feel walls of radial artery by rolling against the bone if the arterial wall is thickened, then it is felt like whip cord:

 

7) Equality on Both Sides: The pulse on the other sides is also examined in respect of all the above points and comparison is made.