tips tricks for getting pulse in the field

LucidResq

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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.
 
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princessretard

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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.
 

18G

Paramedic
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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.
 
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emt seeking first job

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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.
 

akflightmedic

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

himynameismj

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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.
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

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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

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Femoral!

Any tips for femoral?

Never found mine (after extensive searching, too :rolleyes: )

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

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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

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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...
 

himynameismj

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

emtJR86

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

RunnerD1987

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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

Dances with Patients
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Any tips for femoral?

Never found mine (after extensive searching, too :rolleyes: )

never found a patients (when asked to check)

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