The Importance of Feeling a Pulse
All my courses include a discussion of the ABCDE approach to assessing an unwell person. A crucial part of this is measuring the Respiratory Rate and the Pulse. In this blog I’m going to talk in detail about the importance of feeling a pulse.
I teach both in and out of hospital, in all my courses I emphasise the need to actually feel the pulse for yourself. What has prompted this blog is that my mum recently spent a week in hospital and in all the times I saw the nursing staff check her vital signs only one person felt her pulse manually. The ward was a cardiology ward and she had been commenced on various medication that could have adversely affected her heart circulation. Instead of feeling her pulse it was read from the blood pressure machine. So you might wonder why I think this is inadequate – because you miss the qualitative information that feeling a pulse gives you.
In areas where no technology is available to measure the pulse then I think we are inclined to feel it for ourselves. The easiest place to locate a pulse is at the underside of the wrist on the thumb side.
The additional information gathered when you feel a person’s pulse:-
- Their skin temperature
- Any clamminess
- General circulation to fingers
- You make physical contact with the person
- Gives you an opportunity to count their respiratory rate
When you feel the person’s wrist you feel their skin and can gather a lot of information about their condition. Also it creates a human contact which can be comforting. I also use the time when feeling the pulse as an opportunity to count their respiratory rate as the person is not aware that I’m watching their breathing. As soon as we are aware that someone is counting our breaths it’s very difficult not to change the pattern, depth and rate.
Then we get to the pulse!
Importance of Rate
When someone becomes unwell their heart rate may increase as they go into Shock, so knowing the rate is important as it can let you know if they are becoming unwell. I agree that this can be found on a machine, but the following information can not.
Importance of Rhythm
Recently I looked after someone who when I felt his pulse it was irregular (he had missing beats). I wouldn’t and couldn’t have known this if I hadn’t felt it for myself. This led us to consider if his fall could have been related to this and not a simple trip, it was decided to admit him for further investigation – how easy would this have been to miss.
There are lots of reasons why someone’s heart rhythm may be irregular and it’s important to report this. Perhaps this is a change and the cause of them being unwell.
Importance of Volume
When someone goes into Shock their pulse generally increases in rate and decreases in volume. Feeling their pulse gives you this information. Some conditions may cause the pulse to feel ‘bounding’, eg abnormally forceful. Again this is not an abnormality recognised by our technology.
I would urge you next time you’re recording someone’s pulse to feel it for yourself, you really can gain a lot of information that will help them and you.
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