1. Arterial Pulse

2. What do u understand by term PULSE? The alternate expansion and recoil of elastic arteries after each systole of the left ventricle creating a traveling pressure wave that is called the PULSE.

3. Reading the PULSE  Pulses are manually palpated with fingers.  Two or three fingers should be used.  Fingers must be placed near an artery and pressed gently against a firm structure, usually a bone, in order to feel the pulse. bone

4. Common pulse sites Radial Pulse  Lateral aspect of the lower forearm just proximal to the wrist joint  Feel the bony prominence  Move fingertips medially  Tips of fingers drop into a groove in which lies the artery  Examine the pulse by compressing the artery backwards against the bone, using the finger tips

5. The brachial pulse  Medial aspect of the antecubital fossa at the line of the elbow joint.  The artery is felt by compressing backwards with fingers or thumb through the aponeuosis  Divides just below elbow to form radial and ulnararteries

6. Carotid pulse  1-1.5 cm lateral of the midline in the neck at the upper level of the thyroid cartilage  Readily palpable at anterior border of sternomastoid muscle  May be felt with finger tips or thumb which are used to push posteriorly

7. Femoral artery  The femoral artery enters the upper leg by passing under the inguinal ligament.  It enters the leg at the mid- inguinal point.  The femoral artery is usually easily palpated and is an important point of access to the arterial system.

8. Popliteal artery  The popliteal artery is palpable in the popliteal fossa.  The artery passes through the fossa slightly medially to laterally.  The poplitealartery can be palpated in about the midline of the fossa at the level of the femoral condlyes.  Artery best felt with knee in slight flexion.

9. Tibialis posterior artery  The tibialisposterior artery is found on the medial aspect of the ankle.  It is palpable at a position midway between the prominence of the medial malleolus and the prominence of the calcaneus.

10. Dorsalis pedis artery  Dorsalis pedisis a continuation of the tibialis anterior.  Tibialis anterior is often palpable at the ankle joint in a mid-malleolar position, medial to the extensor hallucis longus tendon.

11. Describing the pulse The pulse is described byRateRhythmVolume Synchronous with other pulse or not (Radio-femoral delay). State of the vessel wall

12. Rate The rate of the pulse is recorded in beats per minute. The rate should be counted over a minimum of thirty seconds. The normal resting pulse rate is 72/min. Abnormal slow (bradycardia)<60/min Abnormal fast (tachycardia) >100/min

13. Rhythm The rhythm of the pulse is described as regular or irregular. If irregular the rhythm is described as – –regularly irregular (a recurring pattern of irregularity) – –irregularly irregular (no discernible pattern to the occurrence Of the irregularity

14. Volume The volume of the pulse is a crude indicator of the stroke volume of the heart (the amount of blood ejected by the heart) It is increased in exercise (full or bounding) and reduced in states of low blood volume (weak or thready)

15. State of the vessel wall The normal arterial wall is compressible and has an elastic feel Diseased arteries may feel inelastic and even hard in cases of calcification

16. Heart Sounds

17. Today’s Lab By the end of this practical the student should be able to: To locate all peripheral palpable pulses Examine the radial pulse and comment on pulse rate, rhythm, volume and condition of vessel wall. Demonstrate the effect of exercise on pulse rate. Auscultate for heart sounds

18. 1. Have your partner sit quietly, remaining as relaxed as possible. 2. Locate the radial pulse 3. Record the characteristics of the pulse. 4. Auscultate for the two heart sounds on your partner chest in various areas. 5. Repeat the procedure and determine the pulse rate and auscultate for heart sounds in each of the following conditions: a.Immediately after one minute of exercise b.Immediately after 2 minutes of exercise c.Immediately after 3 minutes of exercise d.3-5 minutes after exercise has ended.

19. 1. Switch partners and repeat steps 2. Tabulate and graph your results and calculate the average pulse of your group

20. Student name Pulse Rte (beats/minute) At Rest1 min exercise 2 minute exercise 3 minutes exercise Group's average pulse

21. Discussion Questions 1. Was your pulse higher or lower than your group's average? Suggest reasons for this. 2. Why can the heart beat be detected as a pulse? 3. Would wrist or neck pulse be felt first following a heart beat? Why? 4. If an accident victim had a severed left subclavian artery, which pulse (neck or wrist) would be most affected? Why? 5. Did you see a difference in your heart rate before and after exercise? Why does this happen? 6. Did the sound of your heartbeat change after exercise? Describe what differences you heard? 7. What causes the characteristic heart sounds? 8. What is pulse deficit and what conditions might cause this?