How to find pulses:
Rules of thumb: Use the pad of your finger, not the tip. Don't push too hard or you can occlude the vessel. Sometimes, using a number of fingertips along the course of a vessel, and applying firmer pressure with the distal fingers will allow you to feel the pulse better in the proximal fingers. It also may help to use one hand to feel a pulse that's easy to get while using the other hand to try to find the harder one - I don't know why this works. If you can't feel the pulse, check capillary refill (squeeze a toe or fingertip - it should pink back up in less than 2 seconds). The Doppler machines on most floors can find pulses that you can't feel.
Record pulses as "2/2" if strong, "1/2" if weak, "0/2" if not present.
|Brachial:|| On the anterior of fold of the elbow, you can feel the biceps tendon, particularly if the patient flexes. Apply fingertip pressure on the medial side of this tendon. The pulse may be more superficial the more proximal you go. Brachial artery - used to be the axillary artery.|
|Radial:|| On the thumb side of the wrist, find the bony prominence (the radial head). Roll your finger medial from this prominence - the artery runs along the bone. Radial artery - branch of the brachial artery.|
|Ulnar:|| On the pinky side of the wrist, find the bony prominence at the base of the hand (pisiform bone). Roll your finger laterally from this prominence - the artery runs alongside this bone. Harder to find than the radial. Ulnar artery - branch of the brachial artery.|
|Femoral:|| (see mnemonics section). In the crease your hip makes when you bend over (along the inguinal ligament), about halfway from the ASIS to the pubic tubercle. Hard to feel (a little deep). Femoral artery - just changed name from iliac artery.|
|Popliteal:|| Very difficult to find. Fairly deep, slightly medial of dead center in posterior knee. Popliteal artery - just changed name from femoral artery.|
|Anterior Tibial:|| Find the tibia (front of the shin), and feel along the lateral edge of the bone (with the tibialis anterior muscle). Easiest to feel about halfway down the shin. Anterior tibial artery - branch of popliteal.|
|DP (dorsalis pedis):|| On the top of the foot, about 1/3 of the way to the toes, feel for the bony prominence on the medial side of the dorsum - the extensor hallucis longus tendon runs along this prominence (make it clear by dorsiflexing the large toe). Roll your finger laterally - the artery runs along the tendon. Dorsalis pedis artery - branch of the anterior tibial (which is a branch of the popliteal).|
|PT (posterior tibial):|| On the medial ankle, find the bony prominence (the medial malleolus). Roll your finger towards the angle of the heel, and feel for the pulse. Posterior tibial artery - branch of popliteal.|
|Head & Neck|
|Common Carotid:|| Only check one at a time. Find the bottom part of the lateral edge of the thyroid cartilege (Adam's apple), then feel 1-2 centimeters lateral to that. Common carotid artery - branch of aorta on the left, brachiocephalic trunk on the right.|
|External Carotid:|| Only check one at a time. About 2 centimeters anterior of the sternocleidomastoid muscle, along the fold of the jaw (the crease made when you put your chin to your chest). External carotid artery - branch of common carotid artery.|
|Temporal:|| Find the top part of the ear that is attached to your face (usually level with the angle of the eye), and about 1 cm anterior is the pulse. Superficial temporal artery - branch of external carotid.|