Only 1/59 (2%) identified pulselessness correctly within 10 s. Of all participants, only 15% (31/206) produced correct diagnoses within 10 s. When no carotid pulse was found, delays were significantly longer (30 s: minimum 13 s), than when a carotid pulse was identified (15 s minimum 3 s) (P < 0.0001). The median diagnostic delay was 24 s (minimum 3 s). Both sensitivity and, to a lesser degree, specificity improved with increasing training blood pressure or heart rate had no significant effect. Thus, although sensitivity of all participants for central pulselessness approached 90%, specificity was only 55%. In 45% (66/147), a pulse was not identified despite a carotid pulse with a systolic pressure > or = 80 mmHg. In 10% (6/59), an absent carotid pulse was not recognized as pulselessness. Time to diagnosis of carotid pulse status, concurrent haemodynamics and diagnostic accuracy were recorded. In 16 patients undergoing coronary artery bypass grafting, four groups of first responders (EMT-1: 107 laypersons with basic life support (BLS) training EMT-2: 16 emergency medical technicians (EMTs) in training PM-1: 74 paramedics in training PM-2: 9 certified paramedics) performed, single-blinded and randomly allocated, carotid pulse assessment either during spontaneous circulation, or during non-pulsatile cardiopulmonary bypass. We aimed (1) to develop a methodology to study diagnostic accuracy in detecting the presence or absence of the carotid pulse in unresponsive patients, and (2) to evaluate diagnostic accuracy and time required by first responders to assess the carotid pulse. However, validation of first responders' assessment of the carotid pulse has begun only recently. The differences in these impulses are illustrated below.Ĭlick on the video icon to review physical exam techniques for evaluation of the carotid impulse.International guidelines for cardiopulmonary resuscitation (CPR) in adults advocate that cardiac arrest be recognized within 5-10 s, by the absence of a pulse in the carotid arteries. It may also be slow-rising and late peaking, pulsus parvus et tardus. A dampened or hypokinetic pulse is characterized as having low amplitude.
In contrast, a hyperkinetic pulse is characterized by a more rapid upstroke and similarly a more rapid downstroke than normal. The normal carotid upstroke is brisk, with a rapid rise leading to the pressure peak, and then falls rapidly in the latter part of systole. Note the character of the upstroke, dicrotic notch and downstroke. The carotid pulse also provides information about left ventricular function and valvular disease. Impairment of one or both sides can be seen in atherosclerotic narrowing, with thrombus, aortic arch disease, dissecting aortic aneurysm or impediment from a cervical rib. Grade the strength of the impulse using a scale of zero to 4+. To assess patency, compare the right carotid artery to the left. Listen here while the patient holds his breath, with the bell or diaphragm of the stethoscope pressed lightly to the skin.Ĭlick on the interactive icon for a review of carotid bruit. Remember that the carotid bulb is up near the angle of the jaw. In some instances auscultating over the carotid for a bruit may be helpful. Evaluation of the character of the impulse sheds light on the integrity of the vascular system as well as intracardiac structures. The characteristics of the carotid wave form are determined by resistance to blood flow in the arterial tree, distensibility of the arterial walls, and the magnitude of the left ventricular impulse.
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