Pulse - Physical Examination

Pulse

Pulse is the expansion felt in an artery where it can be pressed against a bone

Sites

Radial: It is felt with two or three fingers lightly placed on the thumb side of the wrist, anterior surface.

Carotid: This is felt in the neck beside the larynx.

Temporal: It is felt in front of the ear.

Facial: Near the angle of the lower jaw.

Femoral: Felt in the groin

Anterior Fontanel: An infant’s pulse may be felt at the ‘soft spot’ on his head

Observation of the pulse

1.        Rate – Number of pulse beat per minute

2.        Rhythm or Regularity

3.        Strength

Pulse rate

The normal pulse rates for persons at rest are

Adults : 60 to 80 beats/minute

Children : 80 to 100 beats /minute

Infants : 100 to 140 beats /minute

Factors That Affect the Pulse Rate are

1.        Sex: The pulse rate of women is little higher than men

2.        Exercise: The rate increases with exercise and is slower when at rest

3.        Emotion: Anger, fear, joy can increases the pulse rate

4.        Hunger and fatigue: decreases the pulse rate

5.        Drugs : some drugs increase, while others decrease the pulse rate

6.        Acute pain causes an increase in pulse rate

7.        Low blood volume as in dehydration haemorrhage and shock, causes an increase in pulse rate

8.        Heart and thyroid diseases affect the pulse rate.

Tachycardia: Above 100 beats / minute

Bradycardia: Below 60 beats /minute

Taking And Recording The Pulse

The pulse is usually taken along with the temperature. In some cases like after surgery accidents and heart diseases the pulse rate has to be taken and recorded every 15 minutes.

Method

1.        See that the patient is in rest

2.        See that the patent’s arm is well supported

3.        Place the tips of three fingers (never the thumb) gently over the radial artery at the wrist.

4.        Feel the pulsation carefully before starting the count note the strength and regularity of the beats

5.        Using a watch with seconds hand or a pulse oxymeter, count the number of beats for one minute. If necessary count longer to be sure and accurate

6.        Record the pulse rate and note any abnormality in strength or regularity on a JPR chart the pulse rate is often marked in red.

Hand placement for pulse check