checking pulses

[emt seeking first job]

I am at the point where I can get a radial pulse quicker than I could day one.

However, getting a brachial or femoral, I just can not do it yet.

Any ideas on what I am doing wrong? Any pointers ?

 

[mcdonl]

Are you checking brachial and femoral on patients whom you cannot get a radial? Are they pediatric or are you just checking on yourself?

My suggestion, find a co-worker or someone who CAN find one and have them help you. I struggled with femorals a little but but during my intermediate clinical time I helped an MD do a femoral artery stick so I got some good instruction.... he said feel here... I felt there...

Sorry, I guess it is not much advice for you.

 

[emt seeking first job]

Are you checking brachial and femoral on patients whom you cannot get a radial? Are they pediatric or are you just checking on yourself?

My suggestion, find a co-worker or someone who CAN find one and have them help you. I struggled with femorals a little but but during my intermediate clinical time I helped an MD do a femoral artery stick so I got some good instruction.... he said feel here... I felt there...

Sorry, I guess it is not much advice for you.

Sometimes I just cant get the radial. Sometimes because of inury or some device I need to not touch the radial area. Sometimes it is an infant. Sometimes when I do a head to toe assesment I just do it to speed up my learning curve.

 

[Cawolf86]

If you do a head to toe on me please skip my femoral!!

I generally use the femoral during CPR to check if compressions are adequate. The carotid is the right choice for unconscious patients.

I also have trouble finding the brachial on infants - for obtaining V/S I prefer to just auscultate the apical.

 

[BEorP]

If you do a head to toe on me please skip my femoral!!

I generally use the femoral during CPR to check if compressions are adequate. The carotid is the right choice for unconscious patients.

I also have trouble finding the brachial on infants - for obtaining V/S I prefer to just auscultate the apical.

FYI...

Clinicians frequently use the presence or absence of pulses resulting from chest compressions during the resuscitative effort to assess the adequacy of artificial perfusion during CPR. The presence of pulses does not indicate any meaningful arterial blood flow during CPR. No studies have shown the clinical utility of checking pulses during ongoing CPR. A palpable pulse represents the difference between the peak pressure and nadir pressure within a vascular bed. The important factor for perfusion of the myocardium is coronary perfusion pressure (aortic minus right atrial pressure during the relaxation phase of chest compressions). The difference in peak and nadir pressures does not correlate with perfusion. It is important to remember that because there are no valves in the inferior vena cava, retrograde blood flow may occur in the femoral vein. Palpation of a pulse in the femoral area may be misleading and may indicate venous rather than arterial blood flow. In summary, the presence of carotid pulses during CPR may indicate the presence of a pulse wave and perhaps some forward blood flow, but it cannot be used to gauge the efficacy of myocardial or cerebral perfusion from ongoing CPR efforts.

Source: http://circ.ahajournals.org/cgi/content/full/102/suppl_1/I-105

 

[Cawolf86]

Sure I understand but our system requires it to be documented and reported to the base.

 

[RanchoEMT]

I also have trouble finding the brachial on infants - for obtaining V/S I prefer to just auscultate the apical.

Good Point, I Second. its Much easier I've noticed just to listen with a scope on most.

 

[jgoodfernandez]

Just a thought but maybe if you inflate a BP high enough near the deltoid to maybe like 100 mm/hg you may be able to feel it easier but thats only if time permits as well as the patient's status!

 

[samiam]

You can only find a femoral pulse easily if you are laying down. Sitting does NOT work.... I have tried :blush: Follow your illiac crest i.e. hip bone to what would be the center of it. Basically about an inch into your pubic region.

 

[EMSDan]

For me, the brachial seems easier to find if the patients arm is completely extended. Then place your index and middle finger in the medial part of their arm, just below the crease at the elbow. Hope this helps!

 

[emt seeking first job]

I am just curious about this ?

Why is EMS trained to palpate for a pulse to get the heart rate ?

Why cant an EMS person just listen with a scope to the chest and count beats per minute ?

 

[HotelCo]

Why is EMS trained to palpate for a pulse to get the heart rate ?

Why cant an EMS person just listen with a scope to the chest and count beats per minute ?

Auscultate and then tell me if the pulse is strong, or weak.

Rate isn't everything.

 

[emt seeking first job]

Auscultate and then tell me if the pulse is strong, or weak.

Rate isn't everything.

Of course.

If you can't palpate anywhere, but hear one when you ausculate, would you say that was a weak pulse?

 

[HotelCo]

Of course.

If you can't palpate anywhere, but hear one when you ausculate, would you say that was a weak pulse?

If you can't get a pulse ANYWHERE, I suppose you could auscultate to find out the rate, but I'd be more concerned if they're perfusing to the vital organs.

The thing with your example is that you tried to palpate first. Auscultation doesn't replace palpation.

 

[ShotMedic]

Why is EMS trained to palpate for a pulse to get the heart rate ?

Why cant an EMS person just listen with a scope to the chest and count beats per minute ?

A strong and outgoing EMT will apply different methods of obtaining a HR to the bag of tricks. use both noone says you can't

And how many fingers are you using to palpate. The more surface area your searching/feeling for the more likely you will find the pulse. I always laugh when i see brand new EMT students riding a long and searching for ever using just the index and middle finger to palpate. i say use index finger, middle finger, ring finger, and pinkie. or digits 2-5 for the medically termed readers.