Possible differential diagnoses of pulsatile neck vessels include pulsus bisferiens of hypertrophic obstructive cardiomyopathy, pulsus parvus and tardus of AS, dancing carotid of AR, c-v waves of TR (Lancisi sign), cannon a wave of third-degree heart block, and bigeminal pulses of tortuous carotid artery or aortic aneurysms.1 Tortuosity of the common carotid artery is seen especially in women. Why does my pulse in carotid artery feel weak and slow, neck and arms also feel weak, lightheaded and pain in neck and top of chest? 1 doctor answer. 4 doctors weighed in 90,000 U.S. Doctors in 147 specialties are here to answer your questions or offer you advice, prescriptions, and more. To check your pulse over your carotid artery, place your index and middle fingers on your neck to the side of your windpipe. When you feel your pulse, look at your watch and count the number of beats in 15 seconds. Multiply this number by 4 to get your heart rate per minute.
Learn how to check pulse points in this nursing assessment review.
Introduction and Background. The carotid pulse (CP) goes through the surface of the body at the. Find the area on one side of your neck near your windpipe. Your carotid pulse can be taken on either side of your neck. Put the tip of your index and long finger in the groove of your neck along your windpipe to feel the pulse in your carotid artery. Do not press on the carotid artery on both sides of your neck at the same time.
We will review 9 common pulse points on the human body. As a nurse you will be assessing many of these pulse points regularly, while others you will only assess at certain times.
When you assess a pulse point you will be assessing:
- Rate: count the pulse rate for 30 seconds and multiply by 2 if the pulse rate is regular, OR 1 full minute if the pulse rate is irregular.
- Always count the apical pulse for 1 full minute.
- A normal pulse rate in an adult is 60-100 bpm.
- Strength: grade the strength of the pulse and check the pulse points bilaterally and compare them. NOTE: always check the carotid pulse points individually (not at the same time) to avoid stimulating the vagal response.
- 0: absent
- 1+: weak
- 2+: normal
- 3+: bounding
- Rhythm: is the pulse regular or irregular
9 Common Pulse Points (start from head-to-toe…this makes it easier when you have to perform this skill)
- Temporal
- Carotid
- Apical
- Brachial
- Radial
- Femoral
- Popliteal
- Posterior Tibial
- Dorsalis Pedis
Pulse Points Demonstration
Temporal
This artery comes off of the external carotid artery and is found in front of the tragus and above the zygomatic arch (cheekbone). This pulse point is assessed during the head-to-toe assessment of the head.
Carotid
This site is most commonly used during CPR in an adult as a pulse check site. It is a major artery that supplies the neck, face, and brain. As noted above, palpate one side at a time to prevent triggering the vagus nerve, which will decrease the heart rate and circulation to the brain.
To find the carotid pulse point, tilt the head to the side and palpate below the jaw line between the trachea and sternomastoid muscle.
Apical
This site is assessed during the head-to-toe assessment and before the administration of Digoxin. The pulse rate should be 60 bpm or greater in an adult before the administration of Digoxin. Always count the pulse rate for 1 full minute with your stethoscope at this location.
The apical pulse is the point of maximal impulse and is found at the apex of the heart. It is located on the left side of the chest at the 5th intercostal space midclavicular line.
To find the pulse point:
- Locate the sternal notch
- Palpate down the Angle of Louis
- Find the 2nd intercostal space on the left side of the chest
- Go to the 5th intercostal space at the midclavicular line and this is the apical pulse point
Brachial
This is a major artery in the upper arm that divides into the radial and ulnar artery. This site is used to measure blood pressure and as a pulse check site on an infant during CPR.
To find this pulse point, extend the arm and have the palms facing upward. The pulse point is found near the top of the cubital fossa, which is a triangular area that is in front of the elbow.
Radial
This is a major artery in the lower arm that comes off of the brachial artery. It provides circulation to the arm and hand. It is most commonly used as the site to count a heart rate in an adult.
To find this pulse point, extend the arm out and have the palms facing upward. It is found below the thumb in the wrist area along the radial bone.
Femoral
This is a major artery found in the groin and it provides circulation to the legs. This artery is palpated deeply in the groin below the inguinal ligament between the pubic symphysis and anterior superior iliac spine.
Popliteal
This artery is found behind the knee and comes off of the femoral artery. It is a rather deep artery like the femoral.
Carotid Artery Pulse Site
To find the artery, the knee should be flexed. It is located near the middle of the popliteal fossa, which is a diamond-shaped pitted area behind the knee. Use two hands to palpate the artery…one hand assisting to flex the knee and the other to palpate the artery.
Posterior Tibial
This pulse point, along with the dorsal pedis, is assessed during the head-to-toe assessment and is particularly important in patients who have peripheral vascular disease or a vascular procedure (example: heart catheterization when the femoral artery was used to assess the heart).
The posterior tibial pulse point is found on the inside of the ankle between the medial malleolus (bony part of the ankle bone) and Achilles tendon.
Dorsalis Pedis
To find this artery, locate the EHL (extensor hallucis longus) tendon by having the patient extend the big toe. Then palpate down this tendon and when you come to end of it, go to the side of the tendon and you will find this pulse point.
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Correspondingly, is there a difference between radial and carotid pulse?
Carotid Artery Pulse Point
The pulse felt on the neck is called the carotid pulse. When felt on the groin, it is called the femoral pulse. The pulse at your wrist is called the radial pulse.
Also, is your pulse stronger on one side? A strong pulse on the right side with a weak one on the left may suggest an aortic dissection or a stenosis of the left subclavian artery. If a decreased pulse is detected, further evaluation might include ultrasonography or assessments of the ankle brachial index.
Also to know is, why is the carotid pulse the best to use in an emergency?
That is why the peripheral pulse should only be used in people who are well. In emergency situations the central pulse (carotid pulse) should be taken first, as this does not disappear under low blood pressure conditions. The absence of a pulse (central/carotid) means that cardiac arrest has occurred.
Why is radial pulse preferred?
In a conscious adult, the radial artery is the preferred pulse point, for a number of reasons: 1. It's less invasive. Reaching for the femoral artery on the inner thigh, doubly so.