You'd do everything on this list but to keep things concise

this video will focus on the steps in blue and will also cover special populations like infants children and the elderly

As well as a summary

meet Fred

Fred's pulse is between sixty and a hundred beats per minute

The rhythm is regular and on a scale of zero to four the force of Fred's pulse is a three which is normal

But what if Fred's pulse isn't normal?

for starters, the rhythm could be irregular or the pulse could be too slow, fewer than 60 beats per minute

Which is called bradycardia

On the other hand, Fred's pulse could be too quick, more than a hundred beats per minute, which is called tachycardia

Fred's pulse might also be weak and thready

a subjective one or two on the scale of zero to four. That indicates low stroke volume like hemorrhagic shock

On the flip side, Fred's pulse could be full and bounding, a subjective four on the scale of zero to four

That could be from anxiety, heart disease or valvular conditions

let's take Fred's radial pulse we could do this because we want to assess blood flow to the hands or

Because it's one of the most easily accessible pulse locations

First, place your first three fingers at the wrist flexor laterally along the radius bone

Press firmly to obliterate the pulse and then apply a little bit less pressure until you can clearly feel the pulse

Count the first beat you feel as zero

the second beat is one, the third beat is two and so on

is the rhythm regular? if so, count how many beats occur in a 30-second window and multiply by two to get the heart rate

if the rhythm isn't regular, count the number of beats in a full minute

While you count assess the strength of Fred's pulse on a subjective scale of zero to four

Now check the other wrist to assess for symmetry

Both sides are equal on Fred. So both hands are receiving the same amount of blood flow

Now, let's take Fred's carotid pulse

The carotid pulse is also easily accessible, but we can also use it if other pulse sites are not available

First check for obvious pulsations then using your first two or three fingers gently palpate the left then right

artery between the larynx and the interior border of the sternocleidomastoid muscle

Do not palpate both arteries at once that reduces blood flow to the brain

Also don't apply excessive pressure that could cause vagal stimulation

Compare the two sides, a weak pulse might indicate cardiogenic shock, a bounding pulse might indicate aortic regurgitation

Now, let's take Fred's apical pulse

We would take an apical pulse when the radial pulse seems irregular or because Fred's condition requires a more accurate assessment

This is the most reliable

Non-invasive way to obtain his heart rate

With your fingers use anatomical landmarks to find Fred's apical impulse

Find the bony prominence just below the suprasternal notch

That's the angle of Louis, move your fingers down each side of the angle to find the second intercostal space

Then move your fingers down the left side of the sternum to the fifth intercostal space and move laterally to the left midclavicular line

You may find it easier to identify the apical pulse by rolling Fred partway to the left

In cases of cardiac enlargement, the pulse is often found lower and further to the left

place your stethoscope against Fred's apical impulse

When you can hear Fred's heart sounds begin counting his heartbeat same as before

Now that we have a rough idea of both Fred's radial and apical pulses we might have noticed a pulse deficit

a pulse deficit is when the apical pulse is irregular and there's a difference of more than two beats per minute between the radial pulse and

The apical pulse, this may indicate atrial fibrillation

Now let's take Fred's femoral pulse, the femoral pulse is used to assess blood flow in each leg or

During physiological shock or cardiac arrest when other pulses are not palpable

place your first two fingers below the inguinal ligament

midway between the pubic symphysis and the anterior superior iliac spine

an exaggerated femoral pulse is characteristic of Femoral Aneurysm. Alright, let's take Fred's popliteal pulse too

Flex one of Fred's legs a little, it should be relaxed

curl, both hands around the knee and into the popliteal fossa, pressing deep

an exaggerated popliteal pulse is characteristic of a popliteal aneurysm

a diminished popliteal pulse with a normal femoral pulse tells us there's an obstruction of a thigh artery which is characteristic of atherosclerosis

Next, let's take Fred's posterior tibial pulse to assess blood flow to each foot

tell Fred to relax and slightly extend his foot, place your fingers behind and below his ankle bone

and compare both sides

and now, let's take Fred's dorsal pedal's pulse to assess blood flow to each foot again

now again

Tell Fred to relax his foot

Run your fingers in the groove between the extensor tendons of Fred's great toe and his first toe until you feel the pulse

again compare both sides

Fred's dorsal pedal's pulse may be absent for congenital reasons

a diminished dorsal pedal's pulse may indicate peripheral artery disease

If a pulse is hard to find because the patient is young or there's swelling around the limb a portable doppler ultrasound can be used

Apply conductive gel to the skin where the pulse is located then with the ultrasound on

Take the sensor and place it over the pulse. You should hear a regular whooshing sound through the ultrasound speaker

If you don't hear that whooshing sound, readjust until you do find it

Infants have fast resting heart rates, right at birth resting heart rate is between a hundred and a hundred and eighty beats per minute

After a few days the heart rate should decrease to a hundred and twenty to 140 beats per minute

Heart rates will vary by quite a bit between moods

It might go up to a hundred and seventy if the infant is crying or dip down to between seventy and ninety if it's sleeping

Because of the fast heart rate, the easiest way to measure heart rate in infants is by auscultating the apical pulse

Infants also have a heart that's more horizontal than in adults

The apical pulse should be between the fourth intercostal space just lateral to the midclavicular line

As a child ages their resting heart rate will decrease until it stabilizes in adulthood

Thanks for watching

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