# tips tricks for getting pulse in the field



## emt seeking first job (Aug 12, 2010)

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.


----------



## medicRob (Aug 12, 2010)

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







Carotid should be readily palpable as well:






Practice, Practice, Practice.

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


----------



## FreezerStL (Aug 12, 2010)

http://theemtspot.com/category/skills

Enjoy ^_^


Like MedicRob said,

Best way to learn is to practice, practice, practice


----------



## emt seeking first job (Aug 12, 2010)

medicRob said:


> Put on a pair of gloves and practice. The radial pulse should be easily detectable. Don't use your thumb.
> 
> 
> 
> ...




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.


----------



## emt seeking first job (Aug 12, 2010)

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.


----------



## fma08 (Aug 12, 2010)

emt seeking first job said:


> 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.



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.


----------



## emt seeking first job (Aug 12, 2010)

*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.


----------



## Shishkabob (Aug 12, 2010)

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.


----------



## emt seeking first job (Aug 12, 2010)

Linuss said:


> 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.




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)


----------



## reaper (Aug 12, 2010)

No one is that good!


----------



## emt seeking first job (Aug 12, 2010)

reaper said:


> No one is that good!



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....


----------



## gicts (Aug 12, 2010)

emt seeking first job said:


> 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.



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


----------



## emt seeking first job (Aug 12, 2010)

*this is the EXACT response I was seeking......*



gicts said:


> 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.
> 
> ...




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...


----------



## Aidey (Aug 13, 2010)

Practice. 

Really. That is it.


----------



## emt seeking first job (Aug 13, 2010)

Aidey said:


> Practice.
> 
> Really. That is it.



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...


----------



## emt seeking first job (Aug 13, 2010)

*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.


----------



## mgr22 (Aug 13, 2010)

emt seeking first job said:


> 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.



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.


----------



## Aidey (Aug 13, 2010)

emt seeking first job said:


> I practiced in the class even during the downtime.
> 
> I practice on my girlfriend until she gets sick of it.
> 
> ...



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.


----------



## reidnez (Aug 15, 2010)

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.


----------



## jroyster06 (Aug 18, 2010)

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


----------



## LucidResq (Aug 18, 2010)

Once upon a time, I could not for the life of me find my own father's pulse as I was trying to convince him to go to the hosp for cardiac stuff. This was after working in a clinic for nearly 2 years and being damn comfortable with finding pulses. Couldn't get a radial nor carotid. Finally just listened. PS: Also knew how to find his pulse very well as I'd been living alone with him since I was 10 and he's epileptic. Not this time.

My biggest advice would be to practice on the elderly.. the sick... etc. Finding pulses on a healthy young person in your living room is one thing... finding one on a 95 yo dehydrated woman in the back of a rig is something else. Most people are very nice and I doubt your old Great Aunt Sally would object to you practicing your fancy medical skills on her... just be creative and ask around.


----------



## princessretard (Oct 10, 2010)

it can be a little difficult to find a pulse on an elderly pt, but just practice. make sure you press down on the pulse point to actually feel the pulse under your fingers. maybe the pulse happens to be irregular. so if you're trying to feel for it for 2 seconds and dont get anything and move your fingers around..well, just try holding the place for 5seconds and you might get the pulse then. like i said, it might be irregular so it wont be a thready pulse rhythm.


----------



## EMSNicky24 (Oct 14, 2010)

FreezerStL said:


> http://theemtspot.com/category/skills
> 
> Enjoy ^_^
> 
> ...




That's an awesome article! I'm having some trouble getting a BP in the field as well. But I'm getting better and better everyday!


----------



## 18G (Oct 14, 2010)

Some patients naturally have weak and difficult to palpate radial pulses. Just because you can't feel it or it takes a little while to find it doesn't mean you suck at palpating the radial pulse. There are some patients that I have trouble palpating the radial. It's not me its just that patient's vasculature or clinical condition. 

If you can't feel the radial on one side try to palpate it on the other. You can also get a rate apically (listen to the heart).You can make up for not being able to palpate the radial by looking at other perfusion parameters. 

Like everyone else said... there is no special trick it just takes practice.


----------



## emt seeking first job (Oct 15, 2010)

LucidResq said:


> Once upon a time, I could not for the life of me find my own father's pulse as I was trying to convince him to go to the hosp for cardiac stuff. This was after working in a clinic for nearly 2 years and being damn comfortable with finding pulses. Couldn't get a radial nor carotid. Finally just listened. PS: Also knew how to find his pulse very well as I'd been living alone with him since I was 10 and he's epileptic. Not this time.
> 
> My biggest advice would be to practice on the elderly.. the sick... etc. Finding pulses on a healthy young person in your living room is one thing... finding one on a 95 yo dehydrated woman in the back of a rig is something else. Most people are very nice and I doubt your old Great Aunt Sally would object to you practicing your fancy medical skills on her... just be creative and ask around.



Maybe I could volunteer at a nursing home, go around taking vital signs.


----------



## emt seeking first job (Oct 15, 2010)

EMSNicky24 said:


> That's an awesome article! I'm having some trouble getting a BP in the field as well. But I'm getting better and better everyday!





That is an excellent link.

Thank you.

The people on this board rock !!!!!!


----------



## akflightmedic (Oct 15, 2010)

emt seeking first job said:


> he has worked at over a dozen agencies in about four years.



And this is a good thing? This means he is better? Or does this mean he leaves when he is a problem or he is asked to leave?


----------



## emt seeking first job (Oct 15, 2010)

akflightmedic said:


> And this is a good thing? This means he is better? Or does this mean he leaves when he is a problem or he is asked to leave?



Point taken. I left that organization, in part, because of him.

That post was many weeks ago.

I am avoiding disusing him any further with anyone ever.


----------



## akflightmedic (Oct 15, 2010)

No worries...I waited until the thread had been discussed in depth before going off on a tangent...


----------



## emt seeking first job (Oct 15, 2010)

akflightmedic said:


> No worries...I waited until the thread had been discussed in depth before going off on a tangent...




No worries on this end. I have put that service where that person was out of my mind entirely.


----------



## himynameismj (Oct 15, 2010)

emt seeking first job said:


> 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.
> 
> ...



Especially in elder pt's, who may have artery's that have shifted over the years the trick is to not press harder, but softer. while doing so, have them, a partner or yourself hyper extend their wrist. the artery should come up a bit. this should work on increasing a normal pt's pulse surface in the back of the rig as well.


----------



## CAOX3 (Oct 15, 2010)

Is this on everyone or just some?

If you can't get a radial, when you r listening for breath sounds just listen to their heart.


----------



## mikie (Oct 16, 2010)

*Femoral!*

Any tips for femoral?

Never found mine (after extensive searching, too  )

never found a patients (when asked to check)

I know, anatomically, where the vessel passes, but why the heck can't i palpate it?


----------



## himynameismj (Oct 16, 2010)

this should work on any patient. basically, what you are doing is stretching everything in the forearm / wrist, "tightening" the area which in theory brings arteries towards the surface more. older patients are generally where i find more problems with, especially considering any flinch can throw off a found pulse. i have used this in middle aged patients though. but remember, when using this method or any method force is not the key. if you push the artery beyond the pressure it requires to relax, it won't expand at all.


----------



## ZVNEMT (Oct 17, 2010)

I'm lazy and only read the first post, but im just gonna say that on the skinnier Pts i like to go for the brachial pulse instead of radial...


----------



## skivail (Oct 17, 2010)

Try using 4 fingers instead of 1 or 2


----------



## himynameismj (Oct 17, 2010)

I actually had a 44 y/o pt w/ edema today pretty bad. radial pulse was near impossible to find. little hyperextension, gotcha.


----------



## emtJR86 (Oct 18, 2010)

medicRob said:


> Put on a pair of gloves and practice. The radial pulse should be easily detectable. Don't use your thumb.
> 
> 
> 
> ...



Thank you SOOO much. As a student, I haven't yet been shown the proper technique and the illustrations help alot!


----------



## RunnerD1987 (Oct 21, 2010)

emt seeking first job said:


> 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.



+ 1 On that. For the past two days have just begun checking the blood pressure. Find it much easier to go by the pulse from the radial when checking BP, but with the scope it is difficult.


----------



## abckidsmom (Oct 21, 2010)

mikie said:


> Any tips for femoral?
> 
> Never found mine (after extensive searching, too  )
> 
> ...



It's more anterior than you would think.  Runs medial to the iliac crest in a ditch in the pelvis between that and the symphysis pubis, near the top of the leg.  

If you're still having trouble, try and palpate the greater trochanter of the femur, and try again on the anterior aspect of the upper thigh/groin at that level.  

Use three flat fingers and firm, gentle pressure.


----------

