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Importance of examination of Pulse & BP in children.pptx

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Importance of examination of Pulse & BP in children.pptx

  1. 1. WELCOME TO THE SEMINAR Presenter: DR. RENESHA ISLAM Resident, Year 1 Paediatric Haematology & Oncology
  3. 3. What is Pulse ? •Expansion and elongation of arterial wall imparted by the column of blood, passively produced by pressure changes during ventricular systole and diastole.
  4. 4. IMPORTANCE: -Information about- • vessel wall condition. •Rough estimation of SBP. •State of the heart and circulation & -Detection and diagnosis of Arrythmia.
  7. 7. How to feel the Pulse Radial pulse: oThe 3 middle fingers are used oThe palmar surface of the fingers overlies the radial artery and encircles the wrist oAt first the artery is completely occluded, then gradually the pressure released until maximum feeling of the pulse wave is perceived.
  8. 8. Brachial Artery oRest the patient arm with elbow extended & palm up. oUse the thumb of the opposite hand. oCup the hand under the patient elbow. oFeel the pulse just medial to biceps tendon.
  9. 9. Carotid Artery o The patient lies down with the head of the bed elevated 30 degrees. o Carotid pulsations may be visible just medial to sternocleidomastoid. o Place the left thumb on the right carotid in the lower third of the neck at the level of the cricoid cartilage, just inside the medial border of the sternocleidomastoid and press posteriorly. o Never press both carotids at same time.
  10. 10. Femoral Pulse Press deeply below the inguinal ligament and about mid way between Anterior Superior Iliac Spine and Symphysis Pubis.
  11. 11. Popliteal Pulse oPatient’s knee should be flexed. oPlace the finger tips of both hands so that they meet in the middle line behind the knee and press them deeply in the popliteal fossa.
  12. 12. Posterior Tibial Felt behind and slightly below the medial malleolus of the ankle.
  13. 13. Dorsalis Pedis o Feel the dorsum of the foot just lateral to the extensor tendon of the big toe. o If cannot feel the pulse, explore the dorsum of the foot more laterally.
  14. 14. ASSESSMENT OF PULSE 1. RATE (beats/min) - Tachycardia (>100/min) - Bradycardia (<60/min) 2. RHYTHM - Regular - Regularly Irregular (2nd degree heart block) - Irregularly Irregular(Atrial Fibrillation, Ectopic beats) 3. Volume 4. Symmetry
  15. 15. 5. CHARACTER -Catacrotic Pulse - Anacrotic Pulse - Dicrotic Pulse - Pulsus Bisferiens - Pulsus Alternans - Pulsus Bigeminus - Pulsus Paradoxus - Collapsing Pulse 6.Radio-radial and radio-femoral delay 7.Condition of vessel wall
  16. 16. ABNORMAL FINDINGS INPULSE RATE 1. T achycardia(PulseRate>100 bpm) 2.Bradycardia(Pulse Rate<60 bpm)
  17. 17. TACHYCARDIA Sinus rhythm Arrhythmia Exercise Atrial Fibrillation Infants Atrial flutter Excitement/Anxiety VentricularT achycardia Pheochromocytoma Fever Hyperthyroidism MEDICATION: Ca channelblockers(Nifedipine) Sympathomimetics(e.g.salbutamol) Vasodilators
  18. 18. BRADYCARDIA Sinus rhythm Arrhythmia Sleep Carotid Sinus hypersensitivity Athletic training Sick Sinus Syndrome Hypothyroidism Second-Degree heart block MEDICATION: Complete heart block Beta-blockers Digoxin Verapamil,Diltiazem
  19. 19. If Irregular: •Occasionally irregular •Regularly Irregular •Irregularly Irregular
  20. 20. • ABNORMAL FINDINGS IN RHYTHM • If Irregular: • Occasionally irregular • Regularly Irregular • Irregularly Irregular
  21. 21. CAUSES OF RADIOFEMORAL DELAY 1. Coarctation of aorta 2. Artherosclerosis of aorta 3. Thrombosis or embolism of aorta 4. Aortoarteritis
  22. 22. CATACROTIC PULSE Normal arterial pulse: S (Starting point)-Starting point of arterial pulse- wave. Aortic valve opens and the blood of the left ventricle is discharged. P (Percussion wave) -Wave caused from LV ejection that increase the arterial wall linearly. T (Tidal wave)-Reflected wave from the small artery. C (Incisura)-End-point of systolic phase, then aortic valve is closed. D (Dicrotic wave)-Reflective oscillatory wave occurred from the blood crash into aortic valve by blood pressure of aorta. *wavy pattern is not felt in healthy since it is obliterated by normal vascular tone
  23. 23. Anacrotic Pulse Low amplitude pulse Slow rise and late systolic peak.  Seen inAortic Stenosis  Mechanism:Fixed obstruction restricts the rate at which blood can be ejectedfrom the left ventricle.
  24. 24. Dicrotic Pulse T wice beating First wavein systole, second wavei n diastole Occur duetoverylowstroke volume with decreased peripheral resistance. Seen in: Fever (e.g.typhoid fever) CCF CardiacTamponade
  25. 25. Collapsing pulse Sharp rise Ill-sustained Sharp fall Wide pulse pressure(>80mmHg)  collapsing pulse is found in:  Aortic regurgitation  PDA  Large arterio-venous communication
  26. 26. Mechanism Inaorticregurgitation,duringdiastole:  Leftventricle receivesnormal pulmonaryvenous return + portion ofblood ejectedintotheaorta=> largestrokevolume- vigorously ejected=>rapidlyrisingcarotid pulse.  Collapses in early diastole – backflowthrough aortic valve  Exaggerated atthe radialartery by liftng the arm.
  27. 27. Pulsus Bisferiens Increased pulse with double systolic pea k seperated by adistinct mid-systolicdip. Causes: Aortic regurgitation Concomitant aortic stenois and regurgitation
  28. 28. Pulsus bigeminus Regular alteration of pulse pressure amplitude. Caused by premature ventricular contraction that follows each regular beat. Occurs in: AV block Sinoatrial block with Ventricular Escape
  29. 29. Pulsus alternans Beat-to-beat variation in pulse volume with a normal rhythm. Rare Occurs in : Advanced heart failure Toxic myocarditis ParoxysmalTachycardias Following Premature beat
  30. 30. Pulsus Paradoxus Exaggeration of the normal variability of pulse volume with breathing. Inspiratory decline in systolic pressure greater than10mm Hg. Occurs in: Cardiac tamponade Constrictive pericarditis Percardial effusion
  31. 31. APEX PULSE DEFICIT Difference between HR and PR 1. Atrial Fibrillation (>10/min) 2. Multiple ectopics (<10/min)
  32. 32. CAUSES OF ABSENT RADIAL PULSE 1. Anatomical abnormality 2. Severe atherosclerosis 3. Takayasu arteritis (Pulseless disease) 4. Embolism in radial artery