Can't Hear Brachial Pulse

TheSquire, DNP, APRN, NP · Aug 26, 2010

AFAIK, unless you have a Doppler stethoscope, the only pulse in the extremities you should be able to auscultate in a healthy person is the apical pulse.

Ferocity · May 31, 2019

Today was vital signs day for some of our classmates who've yet to sign off on that skill. While i was on break from cardiac life support class i overheard one of our professors talking with my classmate about how a nice stethoscope would improve her ability to take an accurate systolic and diastolic reading. If it's anything like the "three," i bet the littmann cardiology iv is overkill for vital signs... Overkill is a good thing sometimes.

Ever use one of those mdf iconica sphygmomanometers? You've got to give it a try if you ever get the opportunity. Life is enjoyable when you only have one tube coming out of your BP cuff.

Ferocity · May 31, 2019

On 8/26/2010 at 12:46 AM, Factory Ten said:
Today in class we began learning about taking vital signs. When it comes to pulses, though, I've been having a lot of trouble. I can only find the brachial and radial pulses occasionally. And when I try to hear the brachial pulse through my stethoscope, I simply can't. Its the latter issue that's really frustrating me.
Is it commonly possible to auscultate the brachial pulse without the BP cuff being attached and partially inflated? Or is this a sound that I'd most likely only hear with a higher-end stethoscope?

Just practice finding the pulses on yourself, then mark the location you found it at with a marker. do it bilaterally for the brachial, radial, pedal, and yes, the carotid pulses BILATERALLY every day... you'll become pro in no time at all when finding it on your future patients! JUST visualize exactly where the radial artery is ON YOU... then go for it in your patient. You'll get really good and really fast at it like you've been doing it your whole life before the year is out. if you can't find the pulse for the right and left brachial arteries... extend the elbow and poke around the antecubital fossa. THEN MARK IT SO YOU CAN FIND IT THROUGHOUT THE DAY. you'll be pro in no time.

So yeah, that's a firm "no," to both your other questions at the end there. Without altering the circulation of the brachial artery itself somehow, you're technically supposed to hear silence (i think).

Fun fact: In a healthy patient's cardiovascular auscultation, you're supposed to hear silence when you clinically auscultate for the aorta, the right renal artery, the left renal artery, the right iliac artery, the left iliac artery, the right femoral artery, the left femoral artery, the right popliteal artery, the left popliteal artery, the right carotid artery and the left carotid artery! You're supposed to hear silence at each of these... then be happy that your patient has a good cardiovascular architecture lacking bruits.

Honestly I've never listened for anything other than korotkoff sounds on either the left or the right brachial artery. Now a days it is essential to have a sphygmomanometer to generate those korotkoff sounds safely, and properly. Something NO ONE SHOULD EVER DO is that You can use deep palpation to cut off the circulation to the brachial artery with your index finger+third digit, and then slowly relieve pressure... that'll make noise exactly like the korotkoff sounds, THAT, you can put a stethoscope up to! DON'T DO IT THOUGH. It's a large artery, and the possibility of generating damage or worse, a thromboembolism IS VERY REAL. Not to mention it's tricky doing this on yourself TRUST ME. This highly dangerous maneuver is not something to joke about. If you want to hear anything the way you describe it, your patient most likely has to have(atherosclerosis? muscle turning into bone around it? funny anatomy since infancy? a fistula? cancer? a bullet?) something in there making turbulence for you to be able to hear it... in which case YOU DEFINITELY DO NOT WANT TO CRUSH THE BRACHIAL artery in an attempt to hear it better!

I'm pretty sure this is overkill... so I'll end it with a simple diagram. Happiness on its way to you!