![]() Press examiner's left thumb against patient's larynx.Either with thumb of examiner's right hand or index and middle of left hand.Medial border of humerus at elbow medial to biceps tendon.Simultaneously with femoral to detect delay.As ever, in clinical practice there will be some selectivity to save time in the consultation. There are, of course, specific reasons to examine all the pulses at different sites as part of a complete and systematic cardiovascular examination.However, there is much to commend routinely following this with examination of the larger brachial and carotid arteries to feel the nature of the wall and particularly the character of the pulse. Clinically it is traditional to examine the radial pulse first.Such examination technique can be practised according to the requirements of the particular examination to ensure success. In clinical examinations it is important that the student follow instructions and take clues from the questions posed by the examiner and the type of examination (distinguish, for example, between a request to examine a pulse and conducting a cardiovascular examination).This will depend on circumstances and whether there are specific clinical reasons for examining a particular pulse or for systematically examining all arterial pulses. ![]() Other sites may be examined for pulses, in special circumstances - for example, the temporal artery (for tenderness in temporal arteritis) and the ulnar artery (if the radial cannot be felt or before arterial access at the radial site). Palpation of the abdominal aorta would also form part of this systematic examination (to identify abdominal aortic aneurysms for example). Systematic examination normally involves palpating in turn radial, brachial, carotid, femoral and other distal pulses.
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