10/01/25 Lab with Professor Kopp

Patient Assessment and Pulse Check

Introduction to Pulses

• Importance of assessing the patient's pulse.

• Techniques for checking pulses from different arteries:

  • Brachial artery: Used for blood gases.

  • Radial artery: Commonly checked.

  • Carotid artery: Vital for confirming the presence of a pulse, especially in unconscious patients.

  • Femoral artery: Located inside the hip bone; important to practice finding this.

  • Dorsalis pedis: Located on the top of the foot; useful in certain circumstances.

Blood Pressure and Pulse Correlation

• Pulses can indicate blood pressure levels:

  • Radial pulse: Can be felt at a systolic blood pressure of at least $80 ext{ mmHg}$.

  • Brachial pulse: Can be felt at about $70 ext{ mmHg}$.

  • Carotid pulse: Can be felt at around $60 ext{ mmHg}$.

• Importance of checking different arteries if pulses are weak or absent, particularly for unconscious patients. CPR should not be commenced without checking for a carotid or femoral pulse.

Practical Skills in Pulse and Blood Pressure Measurement

• When measuring blood pressure manually:

  • Familiarity and proper technique with a blood pressure cuff is essential.

  • While most hospitals use automatic cuffs, knowing how to do it manually enhances clinical skills and confidence.

Overview of Major Arteries

• Radial artery: Located on the thumb side of the wrist; commonly assessed for pulse.

• Brachial artery: Found in the arm; important for measuring blood pressure in infants and for arterial blood gas sampling.

• Carotid artery: Situated on both sides of the neck; must be palpated carefully to avoid occlusion.

• Femoral artery: Located in the groin, should be assessed with care.

• Dorsalis pedis: Found on the top of the foot; useful in specific situations such as assessing circulation.

Additional Techniques for Assessing Patients

• Breath Sounds Evaluation: Necessary prior to any treatment.

• Follow standard assessment procedure:

  • Introduce yourself to the patient.

  • Visual examination and respiratory rate assessment.

  • Utilize palpation to feel for respiratory expansion.

• Percussion: While not frequently used, can reveal potential lung issues.

  • Resonance indicates normal air-filled lungs.

  • Dullness can indicate pneumonia or fluid.

  • Hyperresonance indicates a pneumothorax.

Breath Sound Identifications

• Normal Breathing Sounds: Clear air movement.

• Diminished Breath Sounds: Indicate a reduction in air movement; may suggest issues like fluid overload or blockage.

• Crackles (formerly known as Rales): Indicate fluid in the airways; heard particularly in the bases of the lungs indicating pulmonary edema.

• Wheezing: A high-pitched sound that indicates constricted airways, typically associated with asthma.

Treatment Protocol for Asthmatic Patients

• Asthmatic patients may receive multiple treatment doses:

  • Nebulization with albuterol and potential continuous treatment for severe cases.

• Consider Heliox treatment (helium-oxygen mixture) for status asthmaticus:

  • The lighter gas allows better airflow down constricted airways, aiding breathing without curing the condition.

Summary of Patient Evaluations

• Always assess pulses and understand their correlation with blood pressure:

  • Radial: $ext{systolic} ext{ BP } ext{ at least } 80$

  • Brachial: $ext{systolic} ext{ BP } ext{ at least } 70$

  • Carotid: $ext{systolic} ext{ BP } ext{ at least } 60$

• Always check breath sounds and be familiar with the assessment process:

  • Inspection, palpation, percussion, and auscultation are key methods in patient evaluations.

• Continuous learning and practice with different techniques, confidently participating in patient care scenarios.