Circulation

Basic circulation

Artery palpation

Heart rate and rhythm, pulse contour/waveform, amplitute/force, symmetry, and obstructions to blood flow

Allen test

Assess patency of ulnar artery

Compress radial and ulnar arteries, have patient open and close fist, release pressure from ulnar artery with the hand open while leaving pressure on radial artery

Watch for color to return within 4-5 seconds

0 pulse

absent, no pulse

+1 pulse

Diminished, barely palpable

+2 pulse

Expected

+3 pulse

Full/increased

+4 pulse

Bounding

Bruit

murmur or unexpected sound with artery auscultation

Low-pitched and hard to hear

Carotid, subclavian, and abdominal aorta

Venous hum

Normal in children

Caused by turbulence of blood flow in internal jugular veins