The Carotid Pulse

After you measure the JVP, move on to assessment of the carotid pulse. The carotid pulse provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve. Take the time to assess the quality of the carotid upstroke, its amplitude and contour, and presence or absence of any overlying thrills or bruits.

For irregular rhythms, see Table 3-10, Selected Heart Rates and Rhythms (p._), and Table 3-4,

Selected Irregular Rhythms (p._).

To assess amplitude and contour, the patient should be lying down with the head of the bed still elevated to about 30°. When feeling for the carotid artery, first inspect the neck for carotid pulsations. These may be visible just medial to the sternomastoid muscles. Then place your left index and middle fingers (or left thumb11) on the right carotid artery in the lower third of the neck, press posteriorly, and feel for pulsations.

A tortuous and kinked carotid artery may produce a unilateral pulsatile bulge.

Carotid Pulse

J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.

Decreased pulsations may be caused by decreased stroke volume, but may also be due to local factors in the artery such as atherosclerotic narrowing or occlusion.

J^ll Although there is a widespread prejudice against using thumbs to assess pulses, they are useful for palpating large arteries.

Press just inside the medial border of a well-relaxed sternomastoid muscle, roughly at the level of the cricoid cartilage. Avoid pressing on the carotid sinus, which lies at the level of the top of the thyroid cartilage. For the left carotid artery, use your right fingers or thumb. Never press both carotids at the same time. This may decrease blood flow to the brain and induce syncope.

Slowly increase pressure until you feel a maximal pulsation, then slowly decrease pressure until you best sense the arterial pressure and contour. Try to assess:

Pressure on the carotid sinus may cause a reflex drop in pulse rate or blood pressure.

See Table 3-9, Abnormalities of the Arterial Pulse and Pressure Waves (p. __).

■ The amplitude of the pulse. This correlates reasonably well with the pulse pressure.

■ The contour of the pulse wave, namely the speed of the upstroke, the duration of its summit, and the speed of the downstroke. The normal upstroke is brisk. It is smooth, rapid, and follows S1 almost immediately. The summit is smooth, rounded, and roughly midsystolic. The downstroke is less abrupt than the upstroke.

■ Any variations in amplitude, either from beat to beat or with respiration.

Thrills and Bruits. During palpation of the carotid artery, you may detect humming vibrations, or thrills, that feel like the throat of a purring cat. Routinely, but especially in the presence of a thrill, you should listen over both carotid arteries with the diaphragm of your stethoscope for a bruit, a murmur-like sound of vascular rather than cardiac origin.

You should also listen for bruits over the carotid arteries if the patient is middle-aged or elderly or if you suspect cerebrovascular disease. Ask the patient to hold breathing for a moment so that breath sounds do not obscure the vascular sound. Heart sounds alone do not constitute a bruit.

Further examination of arterial pulses is described in Chapter 14, The Peripheral Vascular System.

The Brachial Artery. The carotid arteries reflect aortic pulsations more accurately, but in patients with carotid obstruction, kinking, or thrills, they are unsuitable. If so, assess the pulse in the brachial artery, applying e techniques described above for etermining amplitude and contour.

se the index and middle fingers or humb of your opposite hand. Cup

Paradoxical Pulse

Small, thready, or weak pulse in cardiogenic shock; bounding pulse in aortic insufficiency (see p._).

Delayed carotid upstroke in aortic stenosis

Pulsus alternans, bigeminal pulse (beat-to-beat variation); paradoxical pulse (respiratory variation)

A carotid bruit with or without a thrill in a middle-aged or older person suggests but does not prove arterial narrowing. An aortic murmur may radiate to the carotid artery and sound like a bruit.

your hand under the patient's elbow and feel for the pulse just medial to the biceps tendon. The patient's arm should rest with the elbow extended, palm up. With your free hand, you may need to flex the elbow to a varying degree to get optimal muscular relaxation.

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Responses

  • Roman
    When taking a carotid pulse, why not press on both carotids at the same time?
    7 years ago
  • aleesha
    Where to palpate carotid pulse?
    7 years ago
  • marko
    Do both carotid arteries feel the same?
    7 years ago
  • melilot
    How to find brachial artery pulse?
    7 years ago
  • abeba
    How to assess carotid arteries of aged patients?
    7 years ago
  • thorsten
    When palpating the carotid pulse of a responsive older patient you should?
    5 years ago
  • DONALD
    When palpating the carotid pulse of a responsibe older patient, you should?
    5 years ago
  • Brunilde
    How to feel carotid artery?
    3 years ago
  • Ines
    Why is the carotid pulse examined?
    3 years ago
  • RICCARDO
    How to report on amplitude of carotid pulsr?
    3 years ago
  • Bisirat
    How to locate brachial artery?
    3 years ago
  • rosa took-took
    Why carotid artery is pulsated by thumb?
    3 years ago
  • ANN
    Why sholud the carotid pulse not be palpated at the same time?
    2 years ago
  • saradas
    How to palpate for carotid thrill?
    2 years ago
  • minna
    Do not apply pessure to both carotids at same time?
    2 years ago
  • terzo
    Why is the carotid pulse must be taken unilateral?
    2 years ago
  • Maire
    How to locate the carotid artery?
    2 years ago
  • Eleleta
    How to detect carotid pulse sense?
    2 years ago
  • beatrice
    What is tha carotid pluse in work?
    2 years ago
  • robert
    What is caratid pulse?
    2 years ago
  • otho bracegirdle
    Why you should never asses both of your patient's carotid arteries at the same time?
    2 years ago
  • Ted Burrowes
    What does it mean when you find a thrill while examining a carotid pulse?
    2 years ago
  • MANUEL
    Where carotid pulse located?
    1 year ago
  • BIRGIT
    Are carotid artery pulsations visible on inspection?
    1 year ago
  • michelle
    Why should carotid pulse be examined with thumb?
    1 year ago
  • Fikru
    How to examine carotid pulse?
    12 months ago
  • philip
    Can you hear carotid upstroke when taking blood pressure?
    12 months ago
  • JILL
    Why listen for bruit prior to palpating carotid pulse?
    10 months ago
  • ambrosino
    How to assess death by checking carotid pulse?
    10 months ago
  • sandra
    How to check carotid pulse?
    8 months ago
  • J
    How to find carotid artery?
    7 months ago
  • scott
    What should corodid artery pulse feel like?
    4 months ago
  • Szymon
    How to get caroid pulse?
    4 months ago
  • cristiana
    Where to feel carotid pulse med school thyroid or cricoid cartilage?
    2 months ago
  • inigo
    How should the carotid artery pulse feel?
    2 months ago
  • oskari
    What organ system is carotid pulse normal contour?
    1 month ago
  • Conall
    What are hte contours and amplitudes of the carotid pulse?
    16 days ago
  • daniela
    What is the amplitude of carotid pulse normal?
    15 days ago
  • valdemar
    Where to put carotid artery in physical exam?
    6 days ago

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