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The pulse is the perception of the blood flow pulsated by the Cœur by the palpation of a Artère.

Catch of pulse

The catch of pulse consists in supporting with the fingers, through the skin, a Artère against a Os; the pulp of the fingers makes it possible to feel swellings of the artery due to the increase in the blood Pressure by the contraction of the Cœur (Systole).

To take the pulse, it is necessary to use the fingers other than the inch, because an artery passes to the end of the inch and the “  pulse of the pouce  ” can disturb measurement.

The catch of pulse is the manner simplest to evaluate the Cardiac rhythm. The pulses are theoretically symmetrical , i.e. they are felt with the same facility on the right and on the left. A pulse less perceived on a side ( a fortiori if it is abolished) can be an indication of problem located on the artery between the place of palpation and the Aorte.

A normal pulse can be sometimes not easily perceptible because of depth of the artery (typically at an obese patient).

Localization of the principal pulses

Central pulses

In opposition to the peripheral pulses, the central pulses make it possible to make the diagnosis of cardiac arrest when they are not perceived.

  • the Artery carotid on each side of the Neck  :
    on another person, one poses three fingers on the line of centers of the former face of the neck (Trachée), then one makes them slip towards soi  ; when one feels a hollow (between the trachea and the muscle), one delicately inserts the fingers in direction of the spinal column (not to insist if pas  is not found;!)  ;
  • the femoral Artery, (naturally requires to strip the patient partially) in the middle of the fold of the Aine, i.e. halfway of a line linking the iliaque spine (projecting point of the bone of the basin) and the Pubis (crotch).
  • At certain people, the pulsation of the aorta can be directly felt on the abdominal line of centers

Peripheral pulses

The peripheral pulses, or distal pulses, make it possible, when they are found, to measure the heart rate. However, their absence cannot inform about the cardiac activity, but testifies to lesions of the palpated artery. They are more or less easy to find and require sometimes some expérience :

  • on the level of the head:

    • the facial Artery at the sides of the chin,
    • the temporal Artery on the temples,
  • on the level of the upper limbs:
    • the Artery humérale, former face, internal part (nearest to the body when the arm is tended, inch towards outside) fold of the Coude. It is on this level that one poses the Stéthoscope for the measurement of the blood Pressure with a pressure gauge;
    • the radial Artery at the external edge of the wrist (hand turned forwards), between the Radius (bone on the side of the inch) and the tendon. It is the pulse which one usually uses for the measurement of heart rate;
    • the cubital Artère at the edge interns wrist.
  • on the level of the lower extremities:
    • the Artery poplity, inner face behind of the knee. It is the pulse, in practice, most difficult to find.
    • the pedal Artery on the former face of the foot, in general between the first and the second Métatarse (the arterial diagram being different for each person, it may be that it is necessary to seek between others métatarses);
    • the posterior Artery tibiale behind of the internal malleolus.

Utility of the research of the pulses

One can analyze:

  • the force of the pulse, witness of the Pressure blood (more precisely, proportional to the difference between the systolic pressure and the diastolic pressure)   ;
  • the Cardiac rhythm: frequency, regularities or irrégularités  ;
  • reduction or the abolition of a pulse on a side.

The pulse makes it possible to also locate in a simple way an artery.

The pulse is more easily perceptible with the large arteries than are the arteries carotid and femoral (central pulses). The catch of pulse to the wrist (radial pulse) is more comfortable, but it can happen that one feels the central pulses and not the radial pulse, in particular if the blood pressure is low; this situation is frequent at a person having health issues, and in particular in the event of accident or of faintness.

Estimate of the cardiac rhythm

To estimate the Cardiac rhythm, one hopes the number of pulsation felt for a given length of time, and one expresses it in pulsations per minute. The duration must be sufficiently long to be able to estimate the regularity of the pulse and to have a calculation simple, but not too long not to delay others gestures which could be necessary.

Typically, one can count the pulsations durant :

  • one minute: the found number directly gives the frequency in pulsations per minutes; the risk of error is weak, but the duration makes that is conceivable only if no urgent gesture impose  ;
  • fifteen seconds: the number of pulsations found is multiplied by four; one often considers that it is the best compromise between last time and the risk of error, the multiplication by four being an operation enough simple  ;
  • ten seconds: the number of pulsations found is multiplied by six; it is the minimum duration to have an idea of the pulse, but the calculation of head is not very usual.

The average pulse for a person in good health and with calm is of environ :

  • 120 pulsations per minute for a nourrisson  ;
  • 100 pulsations per minute for a child between 1 and 8 ans  ;
  • 60 to 80 pulsations per minute for an adult.
But a person can have a pulse usually more raised or slower, and this because of many factors (disease, regular sporting drive).

An adult having pulse lower than 40 or higher than 120 pulsations per minute at rest, without clear explanation, requires a medical opinion in urgency if it is accompanied by a Malaise because that can be revealing of cardiac problems engraves (see article First aid: alarm). In the other cases, a nonurgent medical opinion is enough.

Estimate of the blood pressure

At the time of the catch of tension with a inflatable arm-band, one takes the distal pulse with the compressed member in order to detect the disappearance and the reappearance of the pulse.

The perception or not of a central or distal pulse is also a method of estimate of the tension (see blood Pressure > Estimation without material ).

At a person presenting a faintness, before the arrival of the doctor

That remains a gesture simple to realize and which allows

  • to give additional details to the medical Régulation (which makes the decision following giving to the call), or with the helps when they arriveront  ;
  • to reassure the victim and the entourage, since a symbolic gesture of medicine is carried out.
The catch of pulse is in addition systematic within the framework of the Prompt help.

A serious evaluation of the circulatory function of a person who breathes comprend :

  • an evaluation of the frequency (beats per minute) and of the regularity of the cardiac rhythm on a pulse central
    the pulse carotidien is more accessible, and the proximity of the Sexe returns the catch of the femoral pulse délicate  ; this evaluation will thus be made in priority on the pulse carotidien, except if its access is difficult (for example fat neck, presence of a cervical Collier)   ;
  • a checking of the presence and symmetry of the pulse radial : if the radial pulse is absent from both side, that can indicate a low pressure artérielle  ; if it is perceived only one side, that can indicate an obstruction of the artery or a Hémorragie on the side where it is not perçu  ;
  • these elements are to be corroborated with other elements external like the presence of Pâleur S with the level of the Muqueuse S, of Sueur S cold and a long time of recoloration of the nails after pressure (see the article Collapsus ), a coldness of the ends, feelings of swarming, to see quantified examinations (like the catch of tension).
At a conscious person, one is often satisfied to take the radial pulse on the two sides (to evaluate frequency, regularity, force and symmetry), and one takes the pulse carotidien only if there is evil to feel the radial pulse.

On an infant (child of less than one year), one in general takes the pulse huméral, on the inner face of the arm (left along the body when the person is upright and that its arms hang): one reason of morphology, it is difficult to see impossible to take a peripheral pulse.

In the event of cardio-circulatory stop

See also: cardiorespiratory Stop, Reanimation cardiopulmonaire

At a person who does not breathe, the catch of a central pulse is in general not relevant because the other signs (absence of breathing, absence of reaction to blowings) are enough to qualify the state. In addition, of the studies (for example) showed that even at trained people (doctors or Secouriste S professionals), there was an error from approximately 50%: in a case on two, the person perceives a pulse whereas there is not, or on the contrary does not perceive any whereas it is present. For these two reasons, the catch of pulse carotidien was removed teaching of first aid at the European level and thus French

The control of the pulse however in general forms part of the assessment in Prompt help (intervention in trained team and with material), and of manner general in the urgent Medical assistance. One controls usually the pulse carotidien during ten seconds.

After a traumatism

The catch of pulse belongs to the general surveillance of the victim, and is similar to the monitoring of a victim of a faintness (cf supra ).

If the radial pulse is perceived only one side, that can indicate a compression of the artery or a Hémorragie on the side where it is not perceived, in particular in the event of Traumatisme (Fracture, Luxation) of the upper limb, or compression (imprisonment in a vehicle, compression by a heavy object, a collapse…) of the upper limb. The catch of radial pulse thus makes it possible to estimate the gravity of the lesion, and in the case of an installation of Attelle, to check that the splint is not too tight.

At a person presenting a traumatism of the basin or a lower extremity, one can test the presence and the symmetry of the pedal or tibiaux pulses posterior for the same reasons. However, those are often difficult to feel even at a person in good health: the perception of a pulse gives information (presence of a perceptible circulation), but the absence of perception of a pulse does not give information, except if one perceived it and that it any more is not perceived. One will thus trust more other criteria like coloring and heat of the ends. If one succeeds in taking the pedal pulse or tibial posterior, it is advised to mark the site on the skin (for example using a felt or of a pen) in order to be able to find it easily.

Particular cases of the traumatic Hemorrhage S on a member when it is not possible to support directly with the main : the treatment of choice, on standby of the medical assumption of responsibility, is the Point compression, i.e. the compression of the artery upstream of the place of the bleeding (artery humérale on the inner face of the arm for the bleedings of upper limb, femoral artery in the dupli medium of the groin for a bleeding of leg, artery carotid for one qaignement with the neck). One in the manners of locating the place where to exert compression is to seek the pulse, since the only difference between the catch of pulse and the point in compression is the force of support. In certain cases, the pulse making it possible to know with precision the optimal place of compression can not be perceived because of fall of the local or general blood pressure. Compression is done then in the supposed zone of the pulse. Its effectiveness is controlled by the stop of the bleeding.

Seek of an arterial disease

The abolition of a pulse can testify to a contracting of an artery by Athérome (the most frequent mechanism), even its occlusion. That can lead, at best with pains of the member reached at the time of an effort ( limping ), at worst with a acute Ischémie, which, if it is not dealt with quickly, can lead to an amputation. A medical opinion is essential especially if there exist symptoms (primarily pains).

Localization of an artery

The pulse is simple means of locating an artery to use it like:
  • place of puncture for taking away (Gas of blood);
    • radial artery in first intention
    • femoral artery
    • cubital artery
  • way initially to mount a probe with an aim diagnosis (tap pressure, arteriography, Coronarographie) or therapeutic (Angioplastie);
    • femoral artery
    • artery humérale
    • radial artery

The pulse constitutes an anatomical reference mark to find others structures :

  • the femoral Veine is punctured in inside of the artery fémorale  ;
  • the jugular Veine interns is punctured in inside of the artery carotid.

In monitoring of certain examinations

The research of the pulses also forms part of the monitoring of the patients in the course of treatment, to detect certain complications. For example, the catch of the pedal and tibiaux pulses posterior, with regular intervals, is systematic in Cardiologie to supervise a patient after a Coronarographie or having a intra-aortic Contrepulsion.

Particular cases

  • the pulse is important forces some in the event of increase in the differential between the systolic pressure and the diastolic pressure. It is the case, in particular, at the time of a aortic insufficiency, being able to go even until a regular shaking of the head ( sign of De Musset of the name of the French poet, carrying an attack of its valve of syphilitic origin .
  • the pulse can vary in force with breathing (moderate blood pressure with the inspiration drops). That is usually nonperceptible at the normal subject. At the time of certain diseases of the Pericardium, the difference can be perceived with palpation: it is the paradoxical pulse .

Complementary explorations

  • the doctor can listen to the pulses using a Stéthoscope. The presence of a breath on this level, inconstant, testifies to the contracting of the artery.
  • the transcription on paper of the mechanical wave of pulse ( carotidogramme for the carotids) is not used any more.
  • the continuous Doppler uses a small probe uninterrupted containing an electric crystal piézo emitting an ultrasound, reverberated by the red globules with a shift of frequency corresponding to a Effect Doppler thus making it possible to calculate in real-time the speed of those. There exist apparatuses Doppler portables (without function of echography) making it possible to see whether a surface artery is permeable, even if one does not feel the corresponding pulse.

See too

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