![]() ![]() Se the index and middle fingers or humb of your opposite hand. If so, assess the pulse in the brachial artery, applying e techniques described above for etermining amplitude and contour. The carotid arteries reflect aortic pulsations more accurately, but in patients with carotid obstruction, kinking, or thrills, they are unsuitable. Heart sounds alone do not constitute a bruit.įurther examination of arterial pulses is described in Chapter 14, The Peripheral Vascular System. Ask the patient to hold breathing for a moment so that breath sounds do not obscure the vascular sound. You should also listen for bruits over the carotid arteries if the patient is middle-aged or elderly or if you suspect cerebrovascular disease. Routinely, but especially in the presence of a thrill, you should listen over both carotid arteries with the diaphragm of your stethoscope for a bruit, a murmur-like sound of vascular rather than cardiac origin. During palpation of the carotid artery, you may detect humming vibrations, or thrills, that feel like the throat of a purring cat. ■ Any variations in amplitude, either from beat to beat or with respiration. The downstroke is less abrupt than the upstroke. The summit is smooth, rounded, and roughly midsystolic. It is smooth, rapid, and follows S1 almost immediately. ■ The contour of the pulse wave, namely the speed of the upstroke, the duration of its summit, and the speed of the downstroke. This correlates reasonably well with the pulse pressure. See Table 3-9, Abnormalities of the Arterial Pulse and Pressure Waves (p. Pressure on the carotid sinus may cause a reflex drop in pulse rate or blood pressure. Slowly increase pressure until you feel a maximal pulsation, then slowly decrease pressure until you best sense the arterial pressure and contour. This may decrease blood flow to the brain and induce syncope. Never press both carotids at the same time. ![]() For the left carotid artery, use your right fingers or thumb. Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage. Press just inside the medial border of a well-relaxed sternomastoid muscle, roughly at the level of the cricoid cartilage. J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.ĭecreased pulsations may be caused by decreased stroke volume, but may also be due to local factors in the artery such as atherosclerotic narrowing or occlusion. Then place your left index and middle fingers (or left thumb11) on the right carotid artery in the lower third of the neck, press posteriorly, and feel for pulsations.Ī tortuous and kinked carotid artery may produce a unilateral pulsatile bulge. These may be visible just medial to the sternomastoid muscles. When feeling for the carotid artery, first inspect the neck for carotid pulsations. To assess amplitude and contour, the patient should be lying down with the head of the bed still elevated to about 30°. Take the time to assess the quality of the carotid upstroke, its amplitude and contour, and presence or absence of any overlying thrills or bruits.įor irregular rhythms, see Table 3-10, Selected Heart Rates and Rhythms (p._), and Table 3-4, The carotid pulse provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve. After you measure the JVP, move on to assessment of the carotid pulse. ![]()
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