Palpate the common carotid artery in the ventral region of the left and right sternocleidomastoid muscle (diagonal neck muscle). The carotids are palpated one after the other. Conversely, simultaneous palpation can lead to a loss of consciousness due to the circulation being cut off to the brain, or bradycardia (low pulse rate) due to vagus stimulation.
Assess:
- Pulse rate (count for a period of 15 seconds or 30 seconds in the event of a high frequency/irregular heartbeat).
- Regularity.
- Amplitude of the pulse wave (intensity).
- Upstroke (rate at which pulse wave rises).
- Presence of thrills (aortic stenosis).
Examples Of Abnormal Pulse Forms:
- Pulsus Tardus: Pulse wave with slow upstroke (aortic stenosis).
- Pulsus Parvus: Pulse wave with low amplitude as a consequence of a low stroke volume (heart failure or aortic stenosis).
- Unequal Pulse: Pulse waves of unequal amplitude and intensity in the case of an irregular rhythm (atrial fibrillation).
- Alternating Pulse: Alternate weak and strong beats in a regular rhythm (severely compromised left ventricular pump function).
- Bigeminal Pulse/Coupled Pulse: Alternate strong and weak beats with alternating time intervals.
- Paradoxical Pulse/Coupled Pulse: Considerable decrease in amplitude during inspiration. This is confirmed by measuring blood pressure: a systolic decrease of (more than 10 mmHg in the carotids) and more than 20 mmHg in the brachial artery during inspiration. For example, in the event of pericardial tamponade (bleeding in the heart sac), constrictive pericarditis or pulmonary embolism.