Pulse: Alternate expansion and recoil of the arterial wall imparted by the column of blood due to pressure changes during ventricular systole and diastole.

Radial pulse:

  • Wrist held in semiflexed and semipronated position
  • Pulp of 3 fingers (index, middle, ring) over wrist
  • Index (disal) finger obliterates artery
  • Middle finger feels pulse
  • Ring (proximal) finger applies pressure
  • To feel collapsing pulse: raise the arm while feeling across the pulse with the fingers of other hand
  • Note: Rate, rhythm, Condition of the arterial wall, Radioradial delay

Brachial pulse:

  • Feel with thumb (right thumb for right arm and vice versa) with other fingers cupping round the back of elbow
  • Medial to tendon of biceps
  • Usually examined during BP measurement

Carotid pulse:

  • Feel with left thumb for right artery and vice versa, one at a time
  • Between larynx and anterior border of sternocleidomastoid
  • Auscultate for bruits
  • Usually examined during auscultation of heart sound
  • Note: Volume, Character

Femoral pulse:

  • With 2 fingers (index and middle)
  • Midinguinal point (Medial to lateral : VAN)
  • Usually examined during drawing of blood from femoral vein
  • Note: Radiofemoral delay

Popliteal artery:

  • With thumbs in front and fingertips behind, having curled both hands into the popliteal fossa
  • Feel for the pulse in midline 3-4 cm below the knee crease
  • Knee flexed 30 degree

Posterior tibial artery:

  • 2cm below and posterior to medial malleolus

Dorsalis pedis artery:

  • Feel in the middle of the dorsum of the foot just lateral to the tendon of extensor hallucis longus
  • Best felt at the proximal extent of the groove between the 1st and 2nd metatarsals
  • Continuation of anterior tibial artery

Recording of individual pulses:
a. Normal : +
b. Reduced: +/-
c. Absent: -
d. Aneurysmal: ++

Examination of Peripheral Pulses

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