II. Exam: Locations

  1. Peripheral arterial pulsation
    1. Arm
      1. Radial pulse (wrist)
      2. Ulnar pulse (wrist)
      3. Brachial pulse (antecubital)
    2. Foot
      1. Posterior tibial pulse
      2. Dorsalis pedis pulse
  2. Central arterial pulsation
    1. Carotid pulse (Neck)
    2. Femoral pulse (Groin)

III. Exam: Pulse loss in Hypotension

  1. In Hypotension, radial pulse is lost first, then femoral and then carotid
    1. Systolic Blood Pressure at which each Blood Pressure is lost is variable per patient
    2. Old ATLS guidelines (see below) appeared to overestimate the systolic Blood Pressure at which pulse was lost by at least 10 mmHg
  2. Old ATLS estimates - deprecated from current ATLS guidelines (cutoff was overestimated by at least 10 mmHg)
    1. Radial pulse present if systolic Blood Pressure >80 mmHg
    2. Femoral pulse present if systolic Blood Pressure >70 mmHg
    3. Carotid pulse present if systolic Blood Pressure >60 mmHg
  3. References
    1. Deakin (2000) BMJ 16:321(7262): 673-4 [PubMed]

IV. Findings: Abnormal

  1. See Arrhthmia for abnormal rate or rhythm
  2. Water-Hammer: Large amplitude, rapidly rising
    1. Hypertrophic Cardiomyopathy
    2. Aortic Regurgitation
    3. Mitral Regurgitation (severe)
    4. Patent Ductus Arteriosus
  3. Pulses parvus et tardus (Small amplitude, slow rising)
    1. Aortic Stenosis
    2. Diminished Cardiac Output
  4. Pulsus alternans (alternating strong and weak pulse)
    1. Left ventricular Systolic Dysfunction
  5. Pulsus Paradoxus (Diminished pulse on inspiration)
    1. Cardiac Tamponade
    2. Congestive Heart Failure (severe)
    3. Chronic Obstructive Pulmonary Disease (severe)
    4. Asthma
    5. Constrictive Pericarditis
  6. Pulsus bisferiens (Double-peak pulse)
    1. Aortic Regurgitation
    2. Hypertrophic Cardiomyopathy
  7. References
    1. Chizner (2002) Dis Mon 48:7-98 [PubMed]
    2. Giese (2007) Am Fam Physician 75:1008-14 [PubMed]

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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 (funciĆ³n), 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