# Palpating Radial Pulse



## LeoLi4 (Feb 1, 2010)

Hi Everyone,  I had recently got hired and I need some help from you guys and ladies. I am having trouble palpating the radial pulse on the patient in the back of the rig while it is moving.  I have no problem locating it, but it is very hard to count the pulse while the rig is going over pot holes and bumps.  Can anyone give me a few pointers on a better way to palpate?  Thanks.


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## mississippimedic (Feb 1, 2010)

Probably just need a little more experience doing it. You should be fine in couple of weeks or so.  Depending on your call volume.


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## VentMedic (Feb 1, 2010)

Palpate the arteries of everyone close to you.  This is also where  routine BLS transfer experience can be of great use.

Learn to position your hands and fingers to have the most stable position. Feel the pulse and appreciate it like those who practice Chinese medicine.   Feel the quality, rate and rhythm.  Learn the anatomical structure around it.  Observe overlying veins which can muffle an arterial pulse.  Check for the ulnar and brachial pulses as well.  Listen apically to see if what you hear is what your fingers feel at the radial artery.


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## PrincessAnika (Feb 1, 2010)

this works for hearing bps as well - place both feet on the bottom rail of the stretcher, and push it against (into) the latch, this will cut down on rattling litter affecting you, and also (when listening for bp) by taking your feet off the floor you do not have nearly as much truck noise......


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## LucidResq (Feb 1, 2010)

I mouth my pulse counts so my ADHD doesn't kick in and distract me, causing me to lose count. 

So I'm mouthing "one... two... three..." etc as I count


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## CollegeBoy (Feb 1, 2010)

I'll honestly admit 3/4 of the time I hook them up to a pulseox and a 3 lead as soon as we're in the back so I dont have to take a pulse again. I do find though that the more contact you have with the patient and the cot, the less the bumps and vibrations will bother you. Also I have to agree with PrincessAnkia; reducing contact with the floor, heck even the seat (sit on the edge), will make it easier.


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## Shishkabob (Feb 1, 2010)

I hope you know that PulseOx takes the average, and not an actual count, and that the monitor doesn't even detect a pulse, correct?


Always do a manual set of vitals before using tech.  Using tech isn't wrong, but don't rely on it, otherwise you're in a pile of doo-doo if a pt crashes and you go to court.


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## CollegeBoy (Feb 1, 2010)

Linuss said:


> I hope you know that PulseOx takes the average, and not an actual count, and that the monitor doesn't even detect a pulse, correct?
> 
> 
> Always do a manual set of vitals before using tech.  Using tech isn't wrong, but don't rely on it, otherwise you're in a pile of doo-doo if a pt crashes and you go to court.



Well yeah thats a given . I always take a set of vitals immeadiately before we start moving. Easier than taking them on the go, and I also have something to compare the tech to and see how its coming out. Thats actually how we discovered we had a patient in A fib once.


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## Shishkabob (Feb 1, 2010)

You mean besides the irregularly irregular pulse?


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## CollegeBoy (Feb 1, 2010)

Linuss said:


> You mean besides the irregularly irregular pulse?



When I took it 5 minutes before it was steady. Otherwise look at my medic, who happens to have A fib problms himself so I am surprised he didnt catch it.


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## emt_angel25 (Feb 1, 2010)

when have having problems with blood pressures one of the medics i work with told me to take a cuff home get a bunch of my friends and drive around and take blood pressures. i did that a few times and havent had a problem since. i think that this may work for your problem as well......


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## LeoLi4 (Feb 4, 2010)

Thanks for the replied.  I guess the only way to this is to keep practice and more patient contact.


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## DrParasite (Feb 4, 2010)

Linuss said:


> Always do a manual set of vitals before using tech.  Using tech isn't wrong, but don't rely on it, otherwise you're in a pile of doo-doo if a pt crashes and you go to court.


sorta like how when a patient walks into an ER's triage area, they take a manual BP and manual pulse right?

or when BLS can't auscultate a BP, ALS always grabs a manual cuff before using the lifepak 12's autocuff right?

I'm sorry, but considering most ERs don't have mechanical BP cuffs except for in cases that the batteries are dead in the dynamap (and even then they grab another one before taking a manual 99% of the time), I am always surprised that so many people insist on "taking a manual first"


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## mycrofft (Feb 4, 2010)

*Turn the wrist over.*

Turn the pt arm so the palm faces downward, put your palm on their dorsal wrist, reach yor fingers over the radial (thumb) wrist and put your fingertips FLAT on the pulsepoint, "thumb free like a pinkie drinking tea". Wiggle the whole thing a little if you need to "slide into" a better position. Do the same for BP's, rotating the arm and relaxing the skeletal muscles and tendons helps get a more intimate steth contact with the blood vessels.
Use search function about getting VS in a moving ambo.


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## usalsfyre (Feb 5, 2010)

I will usually do a quick "too fast, too slow, not strong enough" initial palpation of a radial pulse, however, heart rates and B/Ps are done off the monitor. If the automatic methods don't jive with patient presentation then it's time to investigate further, including taking a manual set of vitals. 

Too many people are scared of the "voodoo box" when automated vital signs monitors have proven to be accurate and reliable.


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## LeoLi4 (Feb 6, 2010)

Too bad at my company we only have BLS rig which have no moniters.  But I believe being able to take the vital or palpate the pulse manually is some what of a basic skill that each emts should be good at.  I personally would love to use the moniter since it will make the job much easier, but being able to manually get a set of vital under any condition will give me a sense of an archivement.


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## leftysoftball (Feb 7, 2010)

mycrofft said:


> Turn the pt arm so the palm faces downward, put your palm on their dorsal wrist, reach yor fingers over the radial (thumb) wrist and put your fingertips FLAT on the pulsepoint, "thumb free like a pinkie drinking tea". Wiggle the whole thing a little if you need to "slide into" a better position. Do the same for BP's, rotating the arm and relaxing the skeletal muscles and tendons helps get a more intimate steth contact with the blood vessels.
> Use search function about getting VS in a moving ambo.



Right on! Works great!


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## RDUNNE (Feb 8, 2010)

I had alot of trouble palpating a radial pulse at first too, but what helped me the most was turning the patients hand palm up and visualizing the spot i needed to palpate rather than trying to be cool and nonchalantly reach over feel it like the medics I was riding with.


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## Bracius (Feb 14, 2010)

mycrofft said:


> Turn the pt arm so the palm faces downward, put your palm on their dorsal wrist, reach yor fingers over the radial (thumb) wrist and put your fingertips FLAT on the pulsepoint, "thumb free like a pinkie drinking tea". Wiggle the whole thing a little if you need to "slide into" a better position. Do the same for BP's, rotating the arm and relaxing the skeletal muscles and tendons helps get a more intimate steth contact with the blood vessels.
> Use search function about getting VS in a moving ambo.



This technique helped me when I was first riding out. My senior EMT told me to play the pulse like the frets on a guitar. Freaking worked like a charm. Haven't lost a pulse yet....well I mean from palpating. <_<


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## OHMEDIC (Feb 19, 2010)

One word...experience.  Don't worry it will come to ya.


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