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How to Count the Pulse Rate by Palpation?

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Palpation of the radial arterial pulse

Palpation of the radial arterial pulse

What is pulse and pulse rate?

Pulse: When heart contracts, the blood is ejected into the aorta with great force. The forceful ejection of blood into the aorta sets up a pressure wave that travels along the arteries. The pressure wave expands and recoils the arterial walls as it travels. The expansion of the arterial walls is palpable as the pulse at any superficial peripheral artery like the radial artery at the wrist.

Pulse rate is the number of pulse per minute. The normal pulse rate in adults is in the range of 60 to 90 beats per minute.

Difference between heart rate and pulse rate

Heart rate is the total number of times the heart contracts (beats) in a minute.

Pulse rate is the total number of times the pressure waves are transmitted to the arteries during contractions of the heart in a minute.

In normal conditions, pulse rate is the accurate measure of heart rate. This implies that in normal health, for every single contraction of the heart, there is a pressure wave in the arteries that expands the peripheral arterial vessels.

In a condition known as pulse deficit, there is a difference in count between the pulse rate and the heart rate. In this case, the pulse rate is counted to be lesser than the heart rate. This is because as the heart is contracting, the pressure waves are not reaching the peripheral vessels.

Normal pulse rate in different age groups

The normal pulse rate varies in different age groups due to the difference in the heart rate. The normal range is as follows:

In fetus: 150 to 180 beats per minute
At birth: 130 to 140 beats per minute
At 10 years of age: 70 to 100 beats per minute
After puberty: 60 to 90 beats per minute

Where to palpate or feel for the pulse?

Usually, the pulse is palpated on the radial artery because it is easily approachable and placed superficially.

The arterial pulse can also be felt in various other superficial arteries on the body.

The areas where the arterial pulse can be palpated are called pulse points.

The various superficial arterial pulses and their area of palpation are as below:

  • Temporal pulse - on superficial temporal artery - over the temple, in front of the ear.
  • Facial pulse - on facial artery - at the angle of the jaw
  • Carotid pulse - on common carotid artery - in the neck along the anterior border of the sternocleidomastoid muscle.
  • Axillary pulse - on axillary artery - in the axilla
  • Brachial pulse - on brachial artery - in cubital fossa along the medial border of the biceps muscle.
  • Radial pulse - on radial artery - over the thumb-side of the wrist.
  • Ulnar pulse - on ulnar artery - over the little finger side of the wrist.
  • Femoral pulse - on femoral artery - in the groin
  • Popliteal pulse - on popliteal artery - behind the knee, in the popliteal fossa
  • Dorsalis pedis pulse - on dorsalis pedis artery - Over the dorsum of the foot
  • Tibial pulse - on posterior tibial artery - Over the back of the ankle, behind medial malleolus.
Sites where the arterial pulse can be felt superficially.

Sites where the arterial pulse can be felt superficially.

How to palpate or feel the pulse?

3 finger method:

The clinically advised method of palpation of the radial artery pulse is the 3 finger method. Pulse is palpated using this method as follows:

  • Make the subject (or) the person in whom you want to examine the pulse sit comfortably with the forearm placed in mid or semi-prone position, with the wrist slightly flexed.
  • Stand preferably by the right side of the subject.
  • Place the tips of the middle three fingers (index finger, middle finger and ring finger) over the radial artery below the wrist at the base of the thumb.
  • Apply light pressure using the fingers until the pulse is felt.
  • If necessary, move the fingers around till the pulse is felt.
  • The proximal finger (the finger close to the heart) is used to occlude blood flow from the radial artery.
  • The distal finger (the finger which is distal to the heart) is used to occlude the ulnar artery pulsations which are entering into the radial artery through the palmar arch.
  • The middle finger is used to assess the pulse.

How to count the pulse rate?

Follow these steps to count the pulse rate:

  • Feel for the radial pulse using the 3 finger method of palpation.
  • It is ideal to let the subject rest for a minute before counting the pulse.
  • Watch the time on your watch.
  • Count the number of pulse waves for one full minute.
  • Record your reading.

Note: In order to get an accurate measure of the pulse rate, check it for 3 times at 10-15 minute intervals.

Factors to note

Various factors such as climbing stairs, a brisk short walk, nervousness, etc. increase the pulse rate. This is the reason why it is essential to check the pulse rate after a minute of rest and at least for 3 times, especially if it is counted to be high. By doing this, one can avoid the error of misreading the changes in pulse rate due to trivial day-to-day activities.

Quiz

For each question, choose the best answer. The answer key is below.

  1. Name the instrument used to graphically study the arterial pulse.
    • Sphygmograph
    • Sphygmomanometer

Answer Key

  1. Sphygmograph

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2021 Angel Writes

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