PUlse Assessment
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Purpose:
To assess if patients have peripheral artery disease (PAD). Identification of PAD is crucial for patients diagnosed with diabetes to provide preventative management of the feet. To assess vital signs to ensure that they are normal for activity. Procedure For both upper and lower extremities:
Position yourself next to the patient and place your 2nd and 3rd finger on the radial pulse. Description of the radial pulse: Lower extremity: Physical Therapist Position: Position yourself next to the patient and place your 2nd and 3rd finger on the dorsalis pedis pulse or posterior tibial pulse Description for Dorsalis Pedis Pulse:
Description of Posterior Tibial Pulse
|
4+ |
Bounding |
3+ |
Increased |
2+ |
Brisk, expected |
1+ |
Diminished, weaker than expected |
0 |
Absent, unable to palpate |
Normal findings are 2+ pulses in both lower extremities. Increased or bounding may be due to exercise or hypertension. Normal rate for an adult is regular, and 60-100 beats per minute.
Abnormal: Decreased or absent pedal pulse (a 0 or 1+ on the scale), decreased or absent radial pulse
Key Clinical Points:
- Finding pedal pulse can be challenging to locate. If having difficulty locating the pedal pulse on one leg, switch to the patient's other leg. Often, knowing the location of one pulse might help you find the pulse on the contralateral side.
- If no pulse is palpated, a doppler at 8 Mhz should be used to detect if blood flow is present in the leg.
- Peripheral Vascular disease (decreased or absent pedal pulse) is considered a risk factor for foot ulcers or amputations with patients diagnosed with diabetes.
- If you are having difficulty, vary the pressure on your fingers to pick up weaker pulses.
- Don’t confuse your own pulse with that of your patient. Compare your own heart rate to the patient since they should be different.
- Screen for peripheral artery disease by using the ankle-brachial index, peripheral pulses are not the most reliable for assessment
References
Mowlavi A, Whiteman J, Neumeister MW et al. Dorsalis pedis pulse: palpation using bony landmark. Postgrad Med J. 2002;78:746-747.
http://pmj.bmj.com/content/78/926/746.full.pdf+html
http://care.diabetesjournals.org/content/27/suppl_1/s63.full.pdf+html
Mowlavi A, Whiteman J, Neumeister MW et al. Dorsalis pedis pulse: palpation using bony landmark. Postgrad Med J. 2002;78:746-747.
- Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003: 448-454.
http://pmj.bmj.com/content/78/926/746.full.pdf+html
http://care.diabetesjournals.org/content/27/suppl_1/s63.full.pdf+html
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