Pulsus Paradoxus

[rhan101277]

I wanted to see if anyone has every experienced this issue with a patient. Wanted to know real life signs of this. It seems like the person can be walking and talking and not have a radial pulse.

It also seems like it would take lots of experience to detect, but being able to detect could save a life or two.

 

[JPINFV]

There are other reasons why a patient can be walking and talking and not have a radial pulse. Some models of LVADs, for example.

 

[MSDeltaFlt]

I wanted to see if anyone has every experienced this issue with a patient. Wanted to know real life signs of this. It seems like the person can be walking and talking and not have a radial pulse.

It also seems like it would take lots of experience to detect, but being able to detect could save a life or two.

It's not common, but it does happen. You will have a radial pulse. It'll just be intermittent, and only on expiration.

http://en.wikipedia.org/wiki/Pulsus_paradoxus

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In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease (e.g. asthma, COPD).[1]
The paradox in pulsus paradoxus is that, on clinical examination, one can also detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul sign). As is usual with inspiration, the heart rate is slightly increased,[2] due to decreased left ventricular output.[3]

 

[emtjack02]

I have seen it but only in the hospital setting. They are pretty impressive to see if you happen to have an art line. I guess my advise would be to take a second listen if you hear the brachial pulse change when listen to your BP. Like the previous poster wrote there are several reasons to cause a PP most of which could be known mhx.

 

[omak42]

I have come across it once in the prehospital setting.....its nothing fantastic. exactly what you would think it is. You are taking a BP, you get your systolic pressure and continue letting air out. All the sudden you stop hearing that thump and mark that as your diastolic. You continue to let the air out only a little quicker now and just as you are about to pull your stethoscope out of your ears you hear another couple thumps....thats about it. Im sure it happens a lot more than we think just because people assume that they are done and stop listening