# Carotid pulse palpation



## rhan101277 (Nov 26, 2008)

We haven't practice this much in class, besides knowing where to locate it at.  Now that we are done with all of the book work, all that is left is practicals and finals.

Anyhow we are taught in class to check the pulse at the carotid artery for someone un-responsive for no more than 15 seconds.  If you can't locate one within that time and they are not breathing you must start CPR until a AED can be brought.

I have practiced on my wife some and find it difficult to find, I know that vigorous palpating can cause bradycardia or even cardiac arrest in some individuals.  I just worry that I may be putting to much pressure trying to find it.  Is it written in stone to check it there?  I find it easier to check the temporal artery, even with low blood pressure or during de-compensated shock I should still be able to feel in there right?

If anyone can give me any tips on palpating it would be great.  Many people where I live have fat necks so :sad: I just don't want to look stupid in front of bystanders.


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## Ridryder911 (Nov 26, 2008)

Practice... practice.....practice.. No joke, alike everything else it doe not come easy. Attempt locating on thinner people first, then once you have mastered and seen where the "norm" is, you will be able to detect them easier. 

R/r 911


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## rhan101277 (Nov 26, 2008)

Ridryder911 said:


> Practice... practice.....practice.. No joke, alike everything else it doe not come easy. Attempt locating on thinner people first, then once you have mastered and seen where the "norm" is, you will be able to detect them easier.
> 
> R/r 911



Yes I hope so, my greatest fear is to be starting CPR on someone when all they need is ventilations.  Since you can have a heart beat but not be breathing, but not for long.


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## Ridryder911 (Nov 27, 2008)

rhan101277 said:


> Yes I hope so, my greatest fear is to be starting CPR on someone when all they need is ventilations.  Since you can have a heart beat but not be breathing, but not for long.



Chances are if they are unresponsive and you cannot feel a carotid pulse, performing compressions probably would not be a bad thing. Chances are they do not have good enough circulation or be severely bradycardiac.

R/r 911


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## Buzz (Nov 27, 2008)

Like Rid said, it's easier to find on thinner people. It's easy to get a little thrown off when you have to dig through folds of skin to find it.


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## FF894 (Nov 27, 2008)

Try palpating on the ipsilateral side, that sometimes helps.  Like the others said, practice on many people.  All of your classmates, friends, family members, etc.  After you palpate their carotid, auscultate their blood pressure to get practice at that as well.


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## rhan101277 (Nov 27, 2008)

FF894 said:


> Try palpating on the ipsilateral side, that sometimes helps.  Like the others said, practice on many people.  All of your classmates, friends, family members, etc.  After you palpate their carotid, auscultate their blood pressure to get practice at that as well.



I always check it on the ipsilateral side, that is how we are trained in class.  I am just going to practice more.


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## FF894 (Nov 27, 2008)

I've seen patients being strangled before  :wacko:   You can also try the femoral pulse in real situations.  Not sure how family and friends will feel about you practicing that one, but its a good one to be able to locate during an arrest.


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## jochi1543 (Nov 28, 2008)

What about auscultating the apical pulse? Gotta be able to hear that one for sure, if present, and the stethoscope would amplify the sounds of a weak pulse. It doesn't tell you anything about peripheral circulation, but it'll tell you whether to start CPR or not.


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## rhan101277 (Nov 28, 2008)

Wonder how come they don't ever mention checking weak pulses with auscultation, especially if you really can't fell them.  I know how to listen for heart and lung sounds, and checking distal pulses is easy.  On most occasions though is systolic is below 80 your probably won't feel any, at least that is what we are taught.  I just need some practice and just need to be confident about what I am taught and just do it.


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## mycrofft (Nov 28, 2008)

*No ausc because CPR is "one size fits all"*

They teach to the lowest common denominator (otherwise unequipped and untrained bystander), or your worst situation (no toys). 

One things I've noted is that most folks needing a carotid pule check are supine or prone, or going there, or need to get there safely. We tend to practice on sitting or standing subjects. Have your brave test partners lay down or at least sit back, things rearrange themselves a little and the carotid may become more palpable. 

Me, I go for the stethoscope.


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