dorsalis pedis pulse
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What is felt is not the blood pulsing through the arteries (as is commonly supposed) but a shock wave that travels along the walls of the arteries as the heart contracts. This shock wave is generated by the pounding of the blood as it is ejected from the heart under pressure. It is analogous to the hammering sound heard in steam pipes as the steam is forced into the pipes under pressure. A pulse in the veins is too weak to be felt, although sometimes it is measured by sphygmograph (see below); the tracing obtained is called a phlebogram.
The pulse is usually felt just inside the wrist below the thumb by placing two or three fingers lightly upon the radial artery. The examiner's thumb is never used to take a pulse because its own pulse is likely to be confused with that of the patient. Pressure should be light; if the artery is pressed too hard, the pulse will disappear entirely. The number of beats felt in exactly 1 minute is the pulse rate.
In taking a pulse, the rate, rhythm, and strength or amplitude of the pulse are noted. The average rate in an adult is between 60 and 100 beats per minute. The rhythm is checked for possible irregularities, which may be an indication of the general condition of the heart and the circulatory system.
The amplitude of a pulse can range from totally impalpable to bounding and full; however, such terms are vague and subject to misinterpretation. To provide a more standardized description of pulse amplitude some agencies and hospitals use a scale that provides a more objective evaluation and reporting of the force of a pulse. On such a scale zero would mean that the pulse cannot be felt; +1 would indicate a thready, weak pulse that is difficult to palpate, fades in and out, and is easily obliterated with slight pressure; +2 would be a pulse that requires light palpation but once located would be stronger than a +1; +3 would be considered normal; and a +4 pulse would be one that is strong, bounding, easily palpated, and perhaps hyperactive, and could indicate a pathological condition such as aortic regurgitation.
If a pulse is noted to be weaker during inhalation and stronger during exhalation (pulsus paradoxus), this could indicate either greater reduction in the flow of blood to the left ventricle than is normal, as in constrictive pericarditis or pericardial effusion, or a grossly exaggerated inspiratory maneuver, as in tracheal obstruction, asthma, or emphysema.
An instrument for registering the movements, form, and force of the arterial pulse is called a sphygmograph. The sphygmographic tracing (or pulse tracing) consists of a curve having a sudden rise (primary elevation) followed by a sudden fall, after which there is a gradual descent marked by a number of secondary elevations.
dorsalis pedis pulse
dorsalis pedis pulsePhysical examination A pulse palpable over the dorsal surface of the foot
dor·sa·lis pe·dis pulse(dōr-sā'lis ped'is pŭls)
pulsepalpable rhythmical dilatation and contraction of an artery, reflecting pressure imposed by cardiac contraction, palpable where superficial arteries overlie bone; three pulses (dorsalis pedis, posterior tibial and peroneal) are palpable in the foot, reflecting arterial supply to the foot by three branches of the popliteal artery; difficult to palpate in oedematous feet; reduced/absent in peripheral vascular disease; enhanced ('bounding') with autonomic neuropathy, e.g. patients with diabetes (Table 1); palpation of foot and limb pulses is facilitated by prior location with a Doppler probe
dorsalis pedis pulse palpable at dorsum of foot, approximately two fingerwidths distal to proximal end of first intermetatarsal space (where perforating artery diverges from dorsal arcuate artery); absent in 5-10% of population
femoral pulse palpable in inguinal fossa, halfway along an imaginary line joining outer and inner margins of anterior aspect of the thigh
peroneal pulse palpable at lateroproximal area of dorsum of foot, approximately 2cm distal to anterior aspect of lateral malleolus
popliteal pulse palpable deep within popliteal fossa, lateral to centre and medial to medial aspect of lateral hamstring
posterior tibial pulse palpable at medial aspect of heel, approximately halfway along an imaginary line from tip of medial malleolus and the point of the heel
tibialis posterior pulse see posterior tibial pulse (above)
venous pulse pathological pulsation in veins, e.g. jugular venous pulse, associated with cardiac dysfunction
|Classification||Explanation of classification|
|0 (0/4)||No pulse detectable = absence of pulses|
|1 (1/4)||Weak pulse = indicative of arterial impairment|
|2 (2/4)||Normal pulse = no arterial disease, no reduction in arterial flow|
|3 (3/4)||Full pulse = pulse greater than expected, perhaps high blood pressure, possible autonomic neuropathy|
|4 (4/4)||Bounding pulse = pulse much greater than expected, probable autonomic neuropathy, possible aneurysm|