This micro lecture is about Circulation Assessment; which forms part of the blended learning materials available to all enrolled students.
In today’s micro-lecture, we’re going to talk about the importance of assessing the pulse. Now, when you’re assessing the circulation, you have to remember that the circulation check not only comes into the primary survey …
In other words, it’s one of the … that the patient assessment categorizations that you’re going to do first, but it’s also something that you’re going to reassess time and time again, all the while you have your patient with you, as part of the reassessment process.
So, primary survey then, danger response, airway, breathing, and circulation. You arrive on scene, you find somebody who’s short of breath. Absolutely, you do your airway check. Have ask to look into their mouth. If their airway’s not blocked, and you’re happy with the airway, move onto breathing. Have a listen to the chest, work out all the characteristics of the breathing you need to do. If you’re happy with that, then move on to circulation. If you’re not happy with breathing, you need to deal with breathing at that point.
Now, feeling for a pulse is something that you will develop the skill over a number of years, and you will become better and better at it the more you do it. Now, circulation, when you’re checking for circulation, you’re feeling for any of the pulse sites. Now, the radial pulse is one of the most commonly palpated pulses on the body because number one, it’s a peripheral pulse site.
What that means is, if there’s a pulse on the peripheries, it means the cardiac … the heart is actually pumping effectively to be able to push the blood all the way to the peripheries. Let’s also remember that a pulse … what a pulse is, is a artery.
It’s a vessel that carries oxygenated blood away from the heart, and you can feel a pulse anywhere where you can push an artery against a bone. And of course, in your studies, you will have seen the different types of arteries that are in the body, so therefore you’ve got an idea of where all the different types of arteries are.
So, let’s start with this radial pulse again. Pressing down here, follow the thumb down, just pressing this groove, if you press too weak, you might not be able to feel it. If you press too hard, you might actually squash it, so you’ll stop feeling it. So, it really is a balance between pressing too hard and pressing too soft.
When you’re palpating a radial pulse, you’re feeling for number one, the presence or absence. If somebody is conscious and talking but they’ve got no radial pulse, chances are they may look unwell. They may look sweaty. They may look hypoxic. You need to give them oxygen straight away for that.
Once you’ve established that there’s no radial pulse there, feel for a carotid pulse, which is just in this groove here, just by your Adam’s apple or your cricothyroid cartilage. And again, don’t press too hard in the neck because it’s a very delicate area. You’re assessing for absence or presence.
You’re assessing for the rate, remembering that an adult heart rate at rest is between 60 to 80 beats per minute. Anywhere between 80 and 100, at rest, you need to establish what’s going on because that’s not normal. And anything over 100 beats a minute is considered to be tachycardia.
Apart from the absence or presence and the rate, you’re also considering the regularity. In other words, is it beating regularly? Or is it irregular? In other words, regularly irregular, or is irregularly regular? All of these things you are actually calculating just by feeling for a pulse. So, you can see the importance of doing it, and you assess it both in the primary survey and in the secondary survey, and routinely on the way to the hospital as well.
So, I hope you’ve enjoyed this micro-lecture just on the pulse. And I look forward to talking to you again shortly. Thanks, guys.
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