STUDY - Technical - New Dacian's Medicine
Pulse
absent (weak) (Classical / Allopathic Medicine)
An
absent or weak pulse may be generalized or may affect only
one extremity. When generalized, this sign is an important
indicator of such life-threatening conditions as shock and
arrhythmia. Localized loss or weakness of a pulse that's
normally present and strong may indicate acute arterial
occlusion, which could require emergency surgery. However,
the pressure of palpation may temporarily diminish or
obliterate superficial pulses, such as the posterior
tibial or the dorsal pedal. Thus, bilateral weakness or
absence of these pulses doesn't necessarily indicate
underlying pathology. (See Evaluating peripheral pulses.)
ALERT:
If you can't detect a pulse:
- check the patient's level of consciousness; if he's unconscious, institute emergency measures
- quickly palpate the remaining arterial pulses to distinguish between localized or generalized loss or weakness
- quickly check other vital signs, and evaluate cardiopulmonary status.
If the patient's condition is localized, perform a focused assessment.
If you can't detect a pulse:
- check the patient's level of consciousness; if he's unconscious, institute emergency measures
- quickly palpate the remaining arterial pulses to distinguish between localized or generalized loss or weakness
- quickly check other vital signs, and evaluate cardiopulmonary status.
If the patient's condition is localized, perform a focused assessment.
HISTORY:
Review the patient's history for cardiac disease, venous insufficiency, and claudication or pain in the extremity.
Ask the patient if he's experiencing pain in the extremity. If so, ask him if it's continuous or intermittent.
Review the patient's history for cardiac disease, venous insufficiency, and claudication or pain in the extremity.
Ask the patient if he's experiencing pain in the extremity. If so, ask him if it's continuous or intermittent.
Evaluating
peripheral pulses
The rate, amplitude, and symmetry of peripheral pulses provide important clues to cardiac function and the quality of peripheral perfusion. To gather these clues, palpate peripheral pulses lightly with the pads of your index, middle, and ring fingers, as space permits.
Rate
Count all pulses for at least 30 seconds (60 seconds when recording vital signs). The normal rate is between 60 and 100 beats/minute.
Amplitude
Palpate the blood vessel during ventricular systole. Describe pulse amplitude by using a scale such as this:
4+ = bounding
3+ = normal
2+ = difficult to palpate
1+ = weak, thready
0 = absent.
Use a stick figure to easily document the location and amplitude of all pulses.
Symmetry
Simultaneously palpate pulses (except the carotid pulse) on both sides of the patient's body, and note inequality. Always assess peripheral pulses methodically, moving from the arms to the legs.
The rate, amplitude, and symmetry of peripheral pulses provide important clues to cardiac function and the quality of peripheral perfusion. To gather these clues, palpate peripheral pulses lightly with the pads of your index, middle, and ring fingers, as space permits.
Rate
Count all pulses for at least 30 seconds (60 seconds when recording vital signs). The normal rate is between 60 and 100 beats/minute.
Amplitude
Palpate the blood vessel during ventricular systole. Describe pulse amplitude by using a scale such as this:
4+ = bounding
3+ = normal
2+ = difficult to palpate
1+ = weak, thready
0 = absent.
Use a stick figure to easily document the location and amplitude of all pulses.
Symmetry
Simultaneously palpate pulses (except the carotid pulse) on both sides of the patient's body, and note inequality. Always assess peripheral pulses methodically, moving from the arms to the legs.
PHYSICAL
ASSESSMENT:
Check the pulses in both extremities. Note the color and temperature of the extremity. Check for a capillary refill.
Perform an abdominal examination to evaluate the presence of an abdominal aortic aneurysm or renal stenosis through the detection of bruits.
Based on your findings, proceed with a more complete examination and interventions.
Check the pulses in both extremities. Note the color and temperature of the extremity. Check for a capillary refill.
Perform an abdominal examination to evaluate the presence of an abdominal aortic aneurysm or renal stenosis through the detection of bruits.
Based on your findings, proceed with a more complete examination and interventions.
SPECIAL
CONSIDERATIONS:
If the pulse is absent in an extremity, don't elevate the extremity. Anticipate preparing the patient for emergency embolectomy or peripheral angioplasty.
If the pulse is absent in an extremity, don't elevate the extremity. Anticipate preparing the patient for emergency embolectomy or peripheral angioplasty.
PEDIATRIC
POINTERS:
Radial, dorsal pedal, and posterior tibial pulses aren't easily palpable in infants and small children, so be careful not to mistake these normally hard-to-find pulses for weak or absent pulses. Instead, palpate the brachial, popliteal, or femoral pulses to evaluate the arterial circulation to the extremities.
In children and young adults, weak or absent femoral and more distal pulses may indicate coarctation of the aorta.
Radial, dorsal pedal, and posterior tibial pulses aren't easily palpable in infants and small children, so be careful not to mistake these normally hard-to-find pulses for weak or absent pulses. Instead, palpate the brachial, popliteal, or femoral pulses to evaluate the arterial circulation to the extremities.
In children and young adults, weak or absent femoral and more distal pulses may indicate coarctation of the aorta.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include arteriography, aortography, and Doppler ultrasonography. If the patient is to have surgery, explain what he can expect postoperatively.
Instruct the patient on what to expect from diagnostic testing, which may include arteriography, aortography, and Doppler ultrasonography. If the patient is to have surgery, explain what he can expect postoperatively.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.