Carotid Pulse

Carotid Pulse +2
Normal Carotid Pulse Rate

The carotid pulse (CP) is a pressure signal acquired over the carotid artery as it passes near the surface of the body at the neck. It delivers a pulse signal signifying the variations in arterial blood pressure and volume with each heartbeat. Better to start at the radial and switch to the carotid in the 1 or 2 out of 1000 cases where the conscious adult with no obvious arm circulation issues lacked a radial pulse. The carotid pulse (CP) is a pressure signal acquired over the carotid artery as it passes near the surface of the body at the neck. It delivers a pulse signal signifying the variations in arterial blood pressure and volume with each heartbeat.

Carotid Pulse +2

The carotid artery can be positioned close to the surface in some individuals. If a person doesnt have extensive fat tissue, and if the neck is held in certain positions its very easy to see the pulsations. Its just a variation of normal in almost all cases, with the rare rare exception of an aneurysm.
Carotid Artery: Plateau pulse – slow rise and slow collapse pulse; may be caused by aortic stenosis, slow ejection of blood through a narrowed aortic valve. Decreases amplitude (grade point pulse) – due to hemorrhagic shock, pulse is weak due to decreased blood volume.

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pulse

[puls] 2. the beat of the heart as felt through the walls of a peripheral artery, such as that felt in the radial artery at the wrist. Other sites for pulse measurement include the side of the neck (carotid artery), the antecubital fossa (brachial artery), the temple (temporal artery), the anterior side of the hip bone (femoral artery), the back of the knee (popliteal artery), and the instep (dorsalis pedis artery).
What is felt is not the blood pulsing through the arteries (as is commonly supposed) but a shock wave that travels along the walls of the arteries as the heart contracts. This shock wave is generated by the pounding of the blood as it is ejected from the heart under pressure. It is analogous to the hammering sound heard in steam pipes as the steam is forced into the pipes under pressure. A pulse in the veins is too weak to be felt, although sometimes it is measured by sphygmograph (see below); the tracing obtained is called a phlebogram.
The pulse is usually felt just inside the wrist below the thumb by placing two or three fingers lightly upon the radial artery. The examiner's thumb is never used to take a pulse because its own pulse is likely to be confused with that of the patient. Pressure should be light; if the artery is pressed too hard, the pulse will disappear entirely. The number of beats felt in exactly 1 minute is the pulse rate.
In taking a pulse, the rate, rhythm, and strength or amplitude of the pulse are noted. The average rate in an adult is between 60 and 100 beats per minute. The rhythm is checked for possible irregularities, which may be an indication of the general condition of the heart and the circulatory system.
The amplitude of a pulse can range from totally impalpable to bounding and full; however, such terms are vague and subject to misinterpretation. To provide a more standardized description of pulse amplitude some agencies and hospitals use a scale that provides a more objective evaluation and reporting of the force of a pulse. On such a scale zero would mean that the pulse cannot be felt; +1 would indicate a thready, weak pulse that is difficult to palpate, fades in and out, and is easily obliterated with slight pressure; +2 would be a pulse that requires light palpation but once located would be stronger than a +1; +3 would be considered normal; and a +4 pulse would be one that is strong, bounding, easily palpated, and perhaps hyperactive, and could indicate a pathological condition such as aortic regurgitation.
If a pulse is noted to be weaker during inhalation and stronger during exhalation (pulsus paradoxus), this could indicate either greater reduction in the flow of blood to the left ventricle than is normal, as in constrictive pericarditis or pericardial effusion, or a grossly exaggerated inspiratory maneuver, as in tracheal obstruction, asthma, or emphysema.
An instrument for registering the movements, form, and force of the arterial pulse is called a sphygmograph. The sphygmographic tracing (or pulse tracing) consists of a curve having a sudden rise (primary elevation) followed by a sudden fall, after which there is a gradual descent marked by a number of secondary elevations.

Pulses palpated during assessment of the arterial system.

alternating pulse one with regular alteration of weak and strong beats without changes in cycle length. Called also pulsus alternans.

anacrotic pulse one in which the ascending limb of the tracing shows a transient drop in amplitude, or a notch.

anadicrotic pulse one in which the ascending limb of the tracing shows two extra small waves or notches.

anatricrotic pulse one in which the ascending limb of the tracing shows three extra small waves or notches.

apical pulse the pulse over the apex of the heart, as heard through a stethoscope or palpated.

atrial venous pulse (atriovenous pulse) a venous pulse in the neck that has an accentuated a wave during atrial systole, owing to increased force of contraction of the right atrium; a characteristic of tricuspid stenosis.

bigeminal pulse one in which two beats occur in rapid succession, the groups of two being separated by a longer interval, usually related to regularly occurring ventricular premature beats. Called also pulsus bigeminus.

brachial pulse that which is felt over the brachial artery at the inner aspect of the elbow; palpated before taking blood pressure to determine location for the stethoscope.

carotid pulse the pulse felt over the carotid artery, which lies between the larynx and the sternocleidomastoid muscle in the neck; frequently used to assess effectiveness of cardiac massage during cardiopulmonary resuscitation. It can be felt by pushing the muscle to the side and pressing against the larynx, or, if the patient is dyspneic, by palpating the pulse at the groove in the muscle.

catadicrotic pulse one in which the descending limb of the tracing shows two small notches.

catatricrotic pulse one in which the descending limb of the tracing shows three small additional waves or notches.

Corrigan's pulse a jerky pulse with full expansion and sudden collapse occurring in aortic regurgitation; called also water-hammer pulse.

dicrotic pulse a pulse characterized by two peaks, the second peak occurring in diastole and being an exaggeration of the dicrotic wave; called also pulsus bisferiens.

dorsalis pedis pulse the pulse felt on the top of the foot, between the first and second metatarsal bones. In 8 to 10 per cent of the population this pulse cannot be detected.

entoptic pulse a subjective sensation of seeing a flash of light in the dark with each heart beat.

femoral pulse one located where the femoral artery passes through the groin in the femoral triangle.

funic pulse the arterial tide in the umbilical cord.

hard pulse (high-tension pulse) one with a gradual impulse, long duration, slow subsidence, and a firm state of the artery between beats.

jerky pulse one in which the artery is suddenly and markedly distended.

paradoxical pulse one that markedly decreases in amplitude during inhalation, as often occurs in constrictive pericarditis.

plateau pulse one that is slowly rising and sustained.

popliteal pulse one palpated in the popliteal fossa, most easily detected when the patient is lying prone with the knee flexed about 45 degrees.

posterior tibial pulse a pulse felt over the posterior tibial artery just posterior to the ankle bone on the inner aspect of the ankle.

quick pulse one that strikes the finger smartly and leaves it quickly; called also pulsus celer.

Quincke's pulse alternate blanching and flushing of the skin that may be elicited in several ways, such as by pressing on the end of the nail and observing the nail bed or skin at the root of the nail. It is caused by pulsation of subpapillary arteriolar and venous plexuses and is sometimes seen in aortic insufficiency, although it may occur in normal persons under certain conditions. Called also capillary pulse (because it was formerly thought to be due to pulsations in the capillaries) and Quincke's sign.

radial pulse that felt over the radial artery at the wrist.

Riegel's pulse one that is diminished during respiration.

slow pulse one with less than the usual number of pulsations per minute; called also vagus pulse and pulsus tardus.

thready pulse one that is very fine and scarcely perceptible.

tricrotic pulse one in which the tracing shows three marked expansions in one beat of the artery.

trigeminal pulse one with a pause after every third beat.

venous pulse the pulsation over a vein, especially over the right jugular vein.

wiry pulse a small, tense pulse.

ca·rot·id pulse

Farlex Partner Medical Dictionary © Farlex 2012

ca·rot·id pulse

(kă-rot'id pŭls)

A palpable rhythmic expansion of the common carotid artery in the neck; palpated during adult cardiopulmonary resuscitation.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

ca·rot·id pulse

(kă-rot'id pŭls)

A palpable rhythmic expansion of the common carotid artery in the neck; palpated during adult cardiopulmonary resuscitation.

Medical Dictionary for the Dental Professions © Farlex 2012

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After you measure the JVP, move on to assessment of the carotid pulse. The carotid pulse provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve. 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.

For irregular rhythms, see Table 3-10, Selected Heart Rates and Rhythms (p._), and Table 3-4,

Selected Irregular Rhythms (p._).

To assess amplitude and contour, the patient should be lying down with the head of the bed still elevated to about 30°. When feeling for the carotid artery, first inspect the neck for carotid pulsations. These may be visible just medial to the sternomastoid muscles. 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.

A tortuous and kinked carotid artery may produce a unilateral pulsatile bulge.

J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.

Decreased 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.

J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.

Press just inside the medial border of a well-relaxed sternomastoid muscle, roughly at the level of the cricoid cartilage. Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage. For the left carotid artery, use your right fingers or thumb. Never press both carotids at the same time. This may decrease blood flow to the brain and induce syncope.

Slowly increase pressure until you feel a maximal pulsation, then slowly decrease pressure until you best sense the arterial pressure and contour. Try to assess:

Pressure on the carotid sinus may cause a reflex drop in pulse rate or blood pressure.

See Table 3-9, Abnormalities of the Arterial Pulse and Pressure Waves (p. __).

■ The amplitude of the pulse. This correlates reasonably well with the pulse pressure.

■ The contour of the pulse wave, namely the speed of the upstroke, the duration of its summit, and the speed of the downstroke. The normal upstroke is brisk. It is smooth, rapid, and follows S1 almost immediately. The summit is smooth, rounded, and roughly midsystolic. The downstroke is less abrupt than the upstroke.

■ Any variations in amplitude, either from beat to beat or with respiration.

Thrills and Bruits. During palpation of the carotid artery, you may detect humming vibrations, or thrills, that feel like the throat of a purring cat. 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.

You should also listen for bruits over the carotid arteries if the patient is middle-aged or elderly or if you suspect cerebrovascular disease. Ask the patient to hold breathing for a moment so that breath sounds do not obscure the vascular sound. Heart sounds alone do not constitute a bruit.

Further examination of arterial pulses is described in Chapter 14, The Peripheral Vascular System.

The Brachial Artery. The carotid arteries reflect aortic pulsations more accurately, but in patients with carotid obstruction, kinking, or thrills, they are unsuitable. If so, assess the pulse in the brachial artery, applying e techniques described above for etermining amplitude and contour.

se the index and middle fingers or humb of your opposite hand. Cup

Normal Carotid Pulse Rate

Small, thready, or weak pulse in cardiogenic shock; bounding pulse in aortic insufficiency (see p._).

Delayed carotid upstroke in aortic stenosis

Pulsus alternans, bigeminal pulse (beat-to-beat variation); paradoxical pulse (respiratory variation)

A carotid bruit with or without a thrill in a middle-aged or older person suggests but does not prove arterial narrowing. An aortic murmur may radiate to the carotid artery and sound like a bruit.

your hand under the patient's elbow and feel for the pulse just medial to the biceps tendon. The patient's arm should rest with the elbow extended, palm up. With your free hand, you may need to flex the elbow to a varying degree to get optimal muscular relaxation.

Continue reading here: The Heart

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