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Clinical Tip

•

When palpating HR, counting pulses for 1 5 seconds

and multiplying by 4 is sufficient with normal rates and

rhythms. [f rates are faster than 1 00 bpm or slower than

60 bpm, they should be palpated for 60 seconds. If the

rhythm is irregularly irregular (e.g., during atrial fibrillation) or regularly irregular (e.g., premature ventricular contractions [PVCs]), auscultation of heart sounds should

be performed to identify the apical HR for a full minute.

CARDIAC SYSTEM

t 7

Table 1-5. Pulse Amplitude Classification and Pulse Abnormalities

Pulse Amplitude Classification

Scale

Degree

Description

o

Absent pulse

No pulse-no circulation

1+

Diminished pulse

Reduced stroke volume and ejection fracrion, Increased vascular

resistance

2+

Normal pulse

Normal resting conditions, no

pathologies

3+

Moderately increased

Slightly increased stroke volume

and ejection fraction

4+

Markedly increased

Increased stroke volume and ejec

(boundlllg)'

tion fraction, can be diminished

with vasoconstriction

Pulse Abnormalities

Abnormality

Palpation

Description

Pulsus

Regular rhythm With

Indicates left ventricular failure

alternans

strong pulse waves

when present at normal heart

alternaring with

rares

weak pulse waves

Bigeminal

Every mher pulse is

Due ro preventricular contractions

pulses

weak and early

(bigeminy)

Pulsus

Reduction in strength

May be caused by chronic obstrucparadoxus

of the pulse with an

tive lung disease, pericarditis,

abnormal decline

pulmonary emboli, restrictive

in blood pressure

cardiomyopathy, and cardioduring inspiration

genic shock

·Corrigan's pulse IS a houndmg pulse viSible in the carotid artery rhat occurs with aorlIC rcgurgltallon.

Source: Data from SL Woods, ES SivaraJian-Froelichcr. S Underhill-Morzer (eds). Car·

dlac NurSing (4th cd). Philadelphia: Lippincott, 2000.

In these cases, palpation of pulse cannot substitute for

ECC analysis ro moniror the patient'S rhythm, but it may

alert the therapist to the onset of these abnormalities.

• Use caution in palpating pulses, as manual pressure on the

carotid sinus may cause reflexive drops in HR, BP, or both.

1 8 ACUTE CARE HANDBOOK FOR PHYSICAL TIIFRAI'ISTS

Carotid ulse

Brachial

Radial

Popliteal Pulse

(posterior knee)

Pedal Pulse

Figure 1 ·6. Arterial pulses. (Draw" by Barbara Cocauour, Ph.D., U"iversity

of Massachusetts, Lowell, Department of Physical Therapy.)