The pulse examination is part of a patient's general objective examination and represents one of the first maneuvers that the doctor performs to get ideas about the patient's clinical condition, usually the radial or carotid pulse is the first to be evaluated.
It is perceived as a lifting of the arterial wall in relation to the arrival of the sphygmic wave. Graphically, it can be represented with a sphygmogram in which an anacrotal branch is registered, a plateau, a catacrotal phase in which an incisure is inserted followed by the dicrota wave.
The
most studied pulses are:
Carotid
The succlavie (in the supra-clavicus fossa)
The humeral
The radial
The ulnar (Allen test, see)
The aortic
The iliac
The femoral
The popliteus
Pedideo
Back tibial
The Allen test (also known as the Allen test) is a clinical test that is used in medicine to assess the blood supply to the hand and fingers and in particular the patency of the radial and ulnar arteries.
The test is also performed to explore the ulnar artery, before performing any arterial blood sampling for blood gas analysis or arterial incannulation, which normally occurs on the radial artery.
In this sense, the test evaluates the ability of the ulnar artery to guarantee an adequate flow of blood to the hand in case of radial occlusion resulting from the aforementioned maneuvers.
The test consists of some sequential stages.
The patient is asked to position his arm vertically and at the same time
forcefully shake his fist in order to eliminate as much blood as possible from
the hand. This effort must be maintained for approximately 30 seconds. Only at
this point the examiner simultaneously compresses the radial and ulnar arteries,
occluding them.
While the compression is maintained the patient reopens the hand, which appears
pale (in particular the nail bed is observed).
The examiner releases the compression of the ulnar artery.
The recoloring time of the hand is normally in the order of 5-7 seconds. According to some studies, 93% of the ulnar arteries and 98% of the radial arteries allow a complete revascularization of the hand within 6 seconds.
If within this time the hand is normally recoloured it is deduced that the blood supply to the hand by the ulnar artery is sufficient and it is therefore possible and reasonably safe to cannulate or puncture the other artery, ie the radial.
If the color of the hand does not return to normal within 7-10 seconds, the test is considered negative and this means that the blood supply to the hand by the ulnar artery is not sufficient.
The radial artery can therefore not be easily pointed or cannulated. As for the radial one, the palpation should be performed with the fingertips of 3 fingers of the hand, middle and annular index that are applied on the artery above the radiocarpal joint, while the thumb tightens the pulse dorsally. To explore the right pulse, use the left hand and the left hand the right hand.
The easiest pulse to find is the radial pulse, which is appreciated with the index finger, on the side of the fingertip, which palpates the course of the artery at the point where it is superficialized and placed on the bone plane.
For the detection of the pulse we use the fingers of the hand, generally index,
middle and ring, avoiding to place the fingers flat, but using the tip of the
same (fingertips) making a slight pressure, the thumb should be kept on the
dorsal region of the pulse same.
Never use your thumb to detect your heart rate, because you may experience a
pulse.
The pulse characters that can be palpably assessed are:
Frequency: however, it must be remembered that the pulse frequency (sphygghage)
does not necessarily correspond to the heart rate. In the presence of atrial
fibrillation or extra-systole for example the frequency perceived at the centrum
cordis does not correspond to the frequency of the sphynx wave in the periphery,
because this frequency is lower, so not all the heart beats correspond to the
propagation of a wave for which has a bradisfigmia with respect to the real
heart rate. On the other hand, as well as a bradisfigmia which does not
correspond to a bradycardia, a tachycardia without tachycardia may also exist.
This can occur if instead of a sphygmic wave you will notice 2: bifid or 2-wave pulse. The first wave is called the "percussion wave" while the second is called the "wave of transmission or tide". The added pulsation can be systolic or diastolic.
The systolic is recorded in the anacrot phase or on the part near the plateau of the wave (pulse bisferiens) in cases of aortic stenosis and of Steno aortic insufficiency. The diatolic is presented as an exaggeration of the normal dichotropous wave that can appear in the states of arterial hypotonia (acute toxins and anemia in hypothesis subjects).
The differentiation between bifid
pulse and bisferiens pulse is made by applying adequate pressure on the pulse
with the finger: in the bifid pulse the second diastolic tip is eliminated,
while in the bisferens it is reinforced.
Rhythm, which means if the pulse is equal, with regular intervals, just like
the music and the beats.
Strength: intensity of impact that receive the fingers that palpate the artery.
It depends on the strength of myocardial contraction.
Amplitude: degree of excursion of the artery. 1. high, aortic insufficiency 2.
small, aortic stenosis, mitral stenosis
Tension or validity: the amount of compression that must be exercised because
the pulsation disappears downstream. The pulse will be tense when the arterial
pressure is high and hypotensive or soft in the opposite case. Palpando the
radial is exercised with the ring finger that is found upstream, a pressure on
the artery, while the other fingers can grasp the moment in which the pulsation
disappears.
Consistency or hardness: chicken trachea.
Duration:
1. rapid or shocking: aortic insufficiency, fever, hyperthyroidism
2. late: aortic stenosis
Equality: normally the beats of the pulse are all the same between them, when
they are not, it is called irregular pulse.
1. alternating, for the deficit of cardiac contractility
2. Kusmaell's paradox pulse: amplitude decreases in inspiration and increases in
expiration. Basically it is physiological until the pressure excursions do not
exceed 10 mmHg. In some conditions, however, this physiological tendency is
accentuated: mediastinal chronic pericarditis and cardiac tamponade.
Symmetry
synchronicity.
When the phonendoscope is placed lightly on a superficial artery of medium or large caliber (axillary, humeral, femoral), a synchronous tone can be appreciated with the cardiac systole (on the subclavian and on the carotid you can hear 2 tones). If there is a significant differential pressure, the conspicuous and sudden distension of the arterial pressure causes a strong and dry tone like a pistol shot. In aortic insufficiency, in addition to a dry tone such as a "pistol shot", a second tone can be heard due to the retraction of the vessel wall and the reflux of blood (double tone of Traube). Furthermore, normally by exerting a slight pressure on the femoral artery with the phonendoscope, stenosis vortices create a systolic murmur. In the aortic insufficiency of breaths we feel 2 for the go and go of the blood, in the sense that there is a regurgitation.
others link
Arrhythmias Sick sinus syndrome Atrio-ventricular block Ventricular Extrasystoles The dangerous atrial fibrillation