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tips tricks for getting pulse in the field

Discussion in 'EMS Talk' started by emt seeking first job, Aug 12, 2010.

  1. BTW, thank you everyone for field documentation tips in my other thread.

    This thread is about finding a pulse, with a gloved hand, where the patient might have trouble sitting still.

    In my emt-b glass, we always did it without gloves, with a quiet and still person.

    I thank all in advance who reply in advance for tricks, tips and work arounds.
  2. medicRob

    medicRob New Member

    Location:
    Nashville, TN
    Put on a pair of gloves and practice. The radial pulse should be easily detectable. Don't use your thumb.

    [​IMG]

    Carotid should be readily palpable as well:

    [​IMG]

    Practice, Practice, Practice.

    Can you give me a specific situation, perhaps elaborate on why the patient can't sit still?
  3. FreezerStL

    FreezerStL New Member

    Location:
    St. Louis
    Last edited by a moderator: Aug 12, 2010

  4. At my vollie, when we see people lying in the sidewalk, on patrol, we stop and do a full assesment, etc.

    These patients end up being some form of intox.

    Although they co-operate, they tend to move around, gesture with their arms when they talk.
  5. Also, I have difficulty finding pulse to check blood pressure, near crease in arm.

    I am practicing on my girl friend ( a physician), and when I vollie, whenever the crew chief delegates that to me.
  6. Just ask politely to have them hold their arm still for a moment. You can even use your other hand to gently hold their arm down to keep it from moving.
  7. thank you so far for replies

    When you guys started, did you ever have to hunt a few seconds to find it.

    That especially happens in the elderly.

    My girlfriend gave me the tip to use index finger mostly.
  8. Linuss

    Linuss Active Member

    Location:
    DFW
    If they are overly fidgety, just forget it until they calm down. If they fidget, chances are they have a pulse. No need to try and wrestle them to figure that out.

  9. Actually to clarify, sometimes it is the fidgeting, but it is mostly I just cant find it, especially with the elderly.

    There is one really gifted guy at my vollie, I watch what he does, his body mechanics, eye movemets, but I am shy to ask him questions, he a bit cocky and impatient and bossy at times (but deserves to be, he is that good)
  10. reaper

    reaper Working Bum

    Location:
    In a Fantasy
    No one is that good!
  11. If I did not see it, I would never believe it.

    He is actually an instructor, he has worked at over a dozen agencies in about four years.

    He has an attitude problem but he does know his stuff. He is actually now working in a diff. field for $, he does this for fun, my vollie has so few experienced people they let him work and do his own thing....
  12. gicts

    gicts New Member

    Location:
    insanity
    I remember back in my ride time, my first trauma. It was an old frail lady who had fallen and been in the cellar for awhile. After we boarded her and put her in the truck, my preceptor, a long time veteran, stopped everything and had me get vitals.

    Between the hypothermia and Parkinson's, I couldn't pick up the radial pulse to save my life. It took him only half a second to locate it and told me if I wanted to stay in this field I needed practice.

    Now every time I find a difficult pulse, I look back on that day and smile.

    To the OP- eventually you will get the hang of it. Practice on anyone who will let you. In less time than you think you'll have the skill under your belt :)
  13. this is the EXACT response I was seeking......


    Tell me, in as much detail as you can recall, the process you wnet through to get from point A (first call) to B today, please...
  14. Aidey

    Aidey Forum Deputy Chiefette Community Leader

    Location:
    USA
    Practice.

    Really. That is it.
  15. I practiced in the class even during the downtime.

    I practice on my girlfriend until she gets sick of it.

    Nobody where I vollie, and the majority of people are in an emt class or about to be in one, have any interest in practicing skills.

    One person, an instructor, offered to help the guys in a class practice practical skills, set out dummies, o2, back board, etc, however, they sort of drifted away and congregated while surfing online videos....(nothing to do with EMS), so the guy who is an instructor walked away...
  16. One specific question:

    Does the pulse in the wrist get stronger or weaker depending on how the wrist is flexed, either extended out towards top of forearm, or down to inside or forearm?

    Does that affect palpating the pulse.
  17. mgr22

    mgr22 Member

    Location:
    Nashville, TN
    EMS Training:
    EMT-Paramedic
    It's harder to palp a radial pulse through a flexed wrist; either extended or neutral would be easier. You might also have more success if the wrist is dependent -- i.e. below the level of the heart. Oh, and don't give up too quickly when you palpate a particular spot. Give yourself a few seconds before moving your fingers.
  18. Aidey

    Aidey Forum Deputy Chiefette Community Leader

    Location:
    USA
    So? Keep practicing. Practicing on the same people over and over again isn't going to make you proficient on everybody. You just have to keep practicing in general.
  19. reidnez

    reidnez New Member

    Location:
    San Diego, CA
    EMS Training:
    EMT-Basic
    Practice! I used to have trouble getting pulses as well, I've gotten a lot better at it. If you don't find one right away, try a couple different sites and try varying your pressure. I have no medical/scientific explanation for this, but sometimes a bit more pressure seems to work and other times a bit lighter pressure seems to work. Just don't go squeezing the crap out of some poor old lady's wrist. Also, there's nothing wrong with going for a carotid if you can't find radial.
  20. jroyster06

    jroyster06 New Member

    Location:
    Monaville, TX
    EMS Training:
    EMT-Paramedic
    Some are harder than others. I was on a truck a couple of weeks ago with a very knowlegable (sp?) medic of 20+ years. I had a very very fait pulse with good 12 lead. It was so faint that the zoll could not read a bp. I tried to ascultate one as well as palpate, neither him nor i could do it. It wasnt till after 800cc's of NS and a good while into our transport that our pack was finally able to pick up a BP. and we wont even talk about IV access with this pt lol

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