The radial pulse is readily felt just lateral to the tendon of the flexor carpi radialis muscle (Fig. 3.12), It is particularly useful for assessing the rale and rhythm of the pulse. The brachial artery can be felt in the brachial fossa immediately medial to the biceps tendon. The carotid pulse is palpable in the neck and provides a better indicator of volume and character than is obtained from the radial pulse.
□ Apply three lingers over the radial pulse at the right wrist (Fig. 3.12A).
□ Use the pulp of the fingers to assess the rate and rhythm.
□ Count the pulse for 15 seconds and multiply by four to obtain pulse rale in beats per minute (b.p.m).
□ To feel for a collapsing pulse, raise the arm while feeling across the pulse with the fingers of the other hand (Fig. 3.12B).
□ Palpate the left radial pulse. If either pulse feels diminished in volume, confirm any difference by simultaneous palpation.
□ Use the thumb (right thumb for right arm and vice versa) with the lingers cupped round the back of the elbow (Fig. 3.13).
□ Feel just medial to the tendon of the biceps muscle to detect the pulse and assess its character.
□ Palpate the carotid pulse with the patient lying on a bed or couch.
□ Never compress both carotids simultaneously.
□ Use the left thumb for Ihe right carotid and vice versa.
□ Place the tip of the thumb between the larynx and the anterior border of the sternocleidomastoid muscle.
□ Press the thumb gently backwards to feel the pulse (Fig. 3.14).
□ Auscultate for bruits by 'walking' the stethoscope up the carotid artery using the diaphragm.
Fig, 3.14 Locating the carotid pulse.
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