Apical Pulse Rate

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Do you use place your hand at the left 5th intercostal space midclavicular ( using the watch) or do you use the stethoscope and using the watch to take the apical pulse rate? I have seen some nurses use the sterthoscope and others their hand, which one is better? ( ex. giving digoxin)

Might be a very dumb question but I am curious :)

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Specializes in multispecialty ICU, SICU including CV.

I was taught in school to use the stethoscope. I've never seen this "hand" method you are discussing done either by an instructor or in practice.

Now I work in the ICU, and we have heart monitors. :)

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Specializes in Case Mgmt, Home Health, Geriatrics.

anyone please correct me if I am wrong, to find the MPI - that's where you need to know where to find it (which is the 5th ICS at left Midclavicular line).... Otherwise i've known (and am guilty) of it myself, to listen to the heart (approx at 5th ICS) and count that as my apical...

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Specializes in Case Mgmt, Home Health, Geriatrics.

with my stethoscope......

1
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I was taught in school to use the stethoscope. I've never seen this "hand" method you are discussing done either by an instructor or in practice.

Now I work in the ICU, and we have heart monitors. :)

Really you never used your hand to take the apical pulse?

When I had to give medications to my patient, my instructor told me to use my index, middle and ring finger to take the apical pulse and at the same time she would use the stethoscope and we both got the same rate.

I am surprised that you never heard of the hand method but it's okay :)

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Specializes in Case Mgmt, Home Health, Geriatrics.
Really you never used your hand to take the apical pulse?

When I had to give medications to my patient, my instructor told me to use my index, middle and ring finger to take the apical pulse and at the same time she would use the stethoscope and we both got the same rate.

I am surprised that you never heard of the hand method but it's okay :)

Wow, sounds cool, but i have never heard or seen of the hand method either. would that work in an obese patient?

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I don't trust heart monitors, because one time I had to give blood pressure med and the monitor showed a heart rate of 80 and I used the hand method and my instructor used the stethoscope and we got 57.

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Wow, sounds cool, but i have never heard or seen of the hand method either. would that work in an obese patient?
Now that's where the problem is with the hand method it is hard to find the apical pulse in an obese person, but most of the time you can find it on others.
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Specializes in multispecialty ICU, SICU including CV.
I don't trust heart monitors, because one time I had to give blood pressure med and the monitor showed a heart rate of 80 and I used the hand method and my instructor used the stethoscope and we got 57.

This is perhaps due to poor cardiac functioning and a decreased EF (the fact that you couldn't hear/feel all the beats), or perhaps abnormal complexes. If the heart isn't pumping particularly hard, any reliable heart monitor is still going to pick up the electrical activity. I can't say I've ever seen this much of a discrepancy with an apical pulse rate before, but I have seen people "lose" beats between their apex (or cardiac monitor) and, say their radial pulse.

Like previous posters have mentioned, patient size or other factors could lead you only partially pick up an apical pulse (and therefore, calculate a lower rate) - but that doesn't mean the heart isn't beating. I always trust the electrical activity on the monitor. If you can read monitors and know to watch for interference, there should be no reason why you wouldn't trust one.

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Ever seen PEA? Pulseless patients with a "normal" narrow complex sinus rhythm? Do not trust the monitor for a rate, ever. Electrical activity may have absolutely nothing to do with mechanical activity.

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Specializes in CT stepdown, hospice, psych, ortho.
Really you never used your hand to take the apical pulse?

When I had to give medications to my patient, my instructor told me to use my index, middle and ring finger to take the apical pulse and at the same time she would use the stethoscope and we both got the same rate.

I am surprised that you never heard of the hand method but it's okay :)

I've never heard of the hand method either. Is that an offical technique or was she just having you take an apical and she was verifying you got it right? In which case, you'd have thought she'd use the hand and have you use the stethoscope. Well, whatever. Nice that it worked. I'd use a stethoscope if given the choice, its much easier to hear without making a mistake than feel IMHO.

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Specializes in multispecialty ICU, SICU including CV.
Ever seen PEA? Pulseless patients with a "normal" narrow complex sinus rhythm? Do not trust the monitor for a rate, ever. Electrical activity may have absolutely nothing to do with mechanical activity.

My understanding is that we are talking about taking an AP on an alert patient. In that context I would trust the monitor.

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