II. Exam: Locations
- Peripheral arterial pulsation
- Arm
- Radial pulse (wrist)
- Ulnar pulse (wrist)
- Brachial pulse (antecubital)
- Foot
- Posterior tibial pulse
- Dorsalis pedis pulse
- Arm
- Central arterial pulsation
- Carotid pulse (Neck)
- Femoral pulse (Groin)
III. Exam: Pulse loss in Hypotension
- In Hypotension, radial pulse is lost first, then femoral and then carotid
- Systolic Blood Pressure at which each Blood Pressure is lost is variable per patient
- Old ATLS guidelines (see below) appeared to overestimate the systolic Blood Pressure at which pulse was lost by at least 10 mmHg
- Old ATLS estimates - deprecated from current ATLS guidelines (cutoff was overestimated by at least 10 mmHg)
- Radial pulse present if systolic Blood Pressure >80 mmHg
- Femoral pulse present if systolic Blood Pressure >70 mmHg
- Carotid pulse present if systolic Blood Pressure >60 mmHg
- References
IV. Findings: Abnormal
- See Arrhythmia for abnormal rate or rhythm
- Water-Hammer Pulse: Large amplitude, rapidly rising (Abrupt Pulse)
- Pulsus parvus et tardus (Small amplitude, slow rising)
- Definitions
- Parvus: Low volume pulse
- Tardus: Slow rate of rise to carotid or brachial pulse - nudge instead of a strong tap
- Causes
- Aortic Stenosis
- Diminished Cardiac Output
- Definitions
- Pulsus Alternans (alternating strong and weak pulse)
-
Pulsus Paradoxus (Diminished pulse on inspiration)
- Cardiac Tamponade
- Congestive Heart Failure (severe)
- Chronic Obstructive Pulmonary Disease (severe)
- Asthma
- Constrictive Pericarditis
- Pulsus Bisferiens (Double-peak pulse)
- Asymmetric Pulse
- Central Causes
- Peripheral Causes
- Peripheral Arterial Disease (to the point of Critical Limb Ischemia)
- Compartment Syndrome (or other acute peripheral vascular compromise)
- References
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 50234002, 415216000 |
| English | Pulsus Bisferiens, pulsus bisferiens (physical finding), pulsus bisferiens, bisferiens arterial pulses were present, Bisferiens pulse, Double pulse, Pulse bisferiens, Double pulse (finding), Pulsus bisferiens, Bisferious pulse, Pulsus bisferiens (finding) |
| Dutch | bisferische pols, pulsus bisferiens |
| French | Pulsus bisferiens |
| German | doppelgipfliger Puls, Pulsus bisferiens |
| Italian | Polso bisferiens, Pulsus bisferiens |
| Portuguese | Pulso biférico, Pulso dícroto |
| Spanish | Pulso bisferiens, Pulso en mitra, pulso bífero (hallazgo), pulso bífero, pulso bisferiens, pulso de doble latido (hallazgo), pulso de doble latido |
| Japanese | 二峰性脈, ﾆﾎｳｾｲﾐｬｸ |
| Czech | Časný dvouvrcholový pulz |
| Hungarian | Bisferius pulzus, Pulzus biszferiens |
Ontology: Pulsus alternans (C0232121)
| Concepts | Finding (T033) |
| SnomedCT | 389358001, 248628005, 390089000, 195099005, 42807005 |
| English | Pulsus Alternans, pulsus alternans (physical finding), pulsus alternans, pulsus alternans was appreciated, alternan pulsus, Pulsus alternans, Pulsus alternans (finding) |
| Dutch | pulsus alternans |
| French | Pouls alternant |
| German | Pulsus alternans |
| Italian | Polso alternante |
| Portuguese | Pulso alternante |
| Spanish | Pulso alternante, pulso alternante (hallazgo), pulso alternante |
| Japanese | 脈交代, ﾐｬｸｺｳﾀｲ |
| Czech | Alternující pulz |
| Hungarian | Pulzus alternáló |
Ontology: Abrupt pulse (C0232126)
| Concepts | Sign or Symptom (T184) |
| SnomedCT | 52147007 |
| English | Abrupt pulse, Abrupt pulse (finding) |
| Spanish | pulso abrupto (hallazgo), pulso abrupto |
Ontology: Abnormal pulse (C0235472)
| Concepts | Finding (T033) |
| SnomedCT | 67683007 |
| LNC | LA17269-4 |
| English | PULSE ABNORMAL, Pulse abnormal NOS, Pulse abnormalities, abnormal pulse, Pulse-abnormal, Pulse abnormal, Abnormal pulse, Abnormal pulse (finding) |
| Italian | Polso anormale, Alterazioni del polso, Polso anormale NAS |
| Dutch | pols abnormaal NAO, pols abnormaliteiten, pols abnormaal |
| French | Pouls anormal SAI, Anomalies du pouls, POULS ANORMAL, Pouls anormal |
| German | Puls anomal NNB, Pulsanomalien, PULSANOMALIE, Puls anomal |
| Portuguese | Anomalias do pulso, Pulso anormal NE, PULSO ANORMAL, Pulso anormal |
| Spanish | Anormalidades del pulso, Pulso anormal NEOM, PULSO ANORMAL, pulso anormal (hallazgo), pulso anormal, Pulso anormal |
| Japanese | 脈拍異常ＮＯＳ, 脈拍異常, ﾐｬｸﾊｸｲｼﾞｮｳ, ﾐｬｸﾊｸｲｼﾞｮｳNOS |
| Czech | Abnormální pulz, Abnormality pulzu, Pulz abnormální NOS |
| Hungarian | Pulzus kóros, Pulzus eltérések, Pulzus kóros k.m.n. |
Ontology: Pulsus parvus et tardus (C0240843)
| Concepts | Finding (T033) |
| SnomedCT | 308531000009104 |
| English | Pulsus parvus et tardus, Pulsus parvus et tardus (finding) |
Ontology: Physiologic pulse (C0391850)
| Definition (NCI) | The rhythmic wave within the arteries occurring with each contraction of the left ventricle. |
| Concepts | Physiologic Function (T039) |
| SnomedCT | 8499008 |
| English | Pulse Rate, Pulse, function, Physiologic pulse, pulse, Pulse, Pulse, function (observable entity), Pulse, NOS, Pulse (function) |
| Spanish | pulso (entidad observable), pulso (función), pulso |
Ontology: arterial pulse (C0392683)
| Concepts | Organ or Tissue Function (T042) |
| SnomedCT | 87179004 |
| English | Arterial Pulse, arterial pulse, Arterial pulse, Pulse (Arterial) |
| Spanish | pulso arterial (entidad observable), pulso arterial |
