The document discusses how to examine the pulse. It defines pulse as the wave form felt at the tip of the finger produced by cardiac systole traveling through the arteries. To assess a pulse, one counts the rate, examines the rhythm, volume, and character by feeling the pulse at the wrist or neck for one minute. The normal pulse rate is 60-100 beats per minute and is regular with normal volume and character. Abnormal pulses can be tachycardia (>100 bpm), bradycardia (<60 bpm), irregular rhythms, abnormal volume such as hypo- or hypervolemic pulses, and abnormal characters including weak, bounding, thready, etc. Causes of abnormal pulses include physiological, cardiovascular

1. EXAMINATION OF PULSE
By
Dr. Md. Razi Ahmad MD(Medicine)
Asist. Prof. GTCH Patna.

2. PULSE ?
Wave form presentation, felt by tip of fingure.
Produce by the cardiac systole, travel in arterial tree
in peripheral direction.
What to assess in a pulse
Rate, Rhythm, Volume, Character
How to assess a pulse
 One/two/three Fingure method
Index fingure or First pore of fingure always inward
direction
Count always full one minute or atleast 30sec x 2

3. Sites of pulse examination

4. Timings of pulse reaching

5. Criteria of Normal Pulse
• Rate:- 60-100beat/minute
• Rhythm:- Regular Sinus
• Volume:- Normal volume pulse assessed by
pulse volume (Systolic-Diastolic) 30-60mmHg
• Character:- Normokinetic which have
percussion and dicortic notch

6. Pulse Rate & its Abnormality
Normal:- 60-100beat/minute
Tachycardia:- >100beat/minute
Bradycardia:- <60beat/minute

7. Causes of Tachycardia
Physiological:- Infants, Children, Emotion,
Exertion etc.
CVS:- Tachyarrhythmia's (SVT, VT, AF etc)
C.F, Cardiogenic Shock, Acute Anterior MI, AV
Fistula, Hypovolemia, Hypotension, etc.
Metabolic:- Thyrotoxicosis,
Pheochromocytoma, Beri-Beri
High Output State:- Anemia, Pyrexia,
Infections etc
Drugs:- Atropine, Pam, Nifedipine, Beta-
agonist, Bronchodilators, Catchecolamines,
Nicotine, Caffeine, etc.
Miscellaneous:-

8. Causes of Bradycardia
Physiological:- Athletes, Deep sleep
Pathological:-
 CVS:- Heart blocks, Sick sinus syndrome,
Inferior wall AMI.
Neurogenic:- Increased ICP/IOP, Narcotic
poison, Brain Tumor.
Metabolic:- Myxoedema, Hypothermia, Severe
Hypoxia, Obstructive Jaundice.
Drugs:- Anti-Arrhythmatic (Beta-blockers,
Dilteazem, Verapamil, Amaderone, Digoxin etc.
Miscellaneous:- Enteric Fever

9. Rhythm of Pulse
Normal:- Regular Sinus
Abnormal Rhythm:-
I. Regularly Irregular:- Atrial
Tachyarrhythmia's, PAT, Atrial Flutter with Fixed
AV block.
II. Irregularly Irregular:- Atrial/Ventricular
ectopics, Atrial Fibrillation, Atrial
Tachyarrhythmia's, Atrial Flutter/Fibrillation with
varying AV block.

10. Pulse Volume
Pulse Volume = Pulse Pressure = Systolic BP -
Diastolic BP (120-80=40)
Normal:- 30-60mmHg
Abnormal:-
I. Hypovolmic Pulse:- Shocks, Sever Infections,
Hemorrhage, Dehydration, Burn, DKA etc.
II. Hypervolmic:- Fluid overload, Hypertension,
Atherosclerosis, Anemia, Thyrotoxicosis, Beri-Beri
etc.

11. Pulse Character

12. Abnormal Pulse Character

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