Regular bradycardia. Chaotic or irregular slowing suggests paroxysmal atrial tachycardia with block or second-degree AV block. A slow, regular rhythm rules out atrial fibrillation. A rhythm that normalizes during exercise suggests atrial flutter or paroxysmal atrial tachycardia with block. Irregular tachycardia. If the rhythm becomes slow and irregular, then check rhythm with exercise. If slowing and recovery are chaotic, then the condition is probably atrial flutter or paroxysmal atrial tachycardia with block. If the rate slows gradually, then the condition is probably sinus tachycardia. If the rate slows only slightly, then the condition is not ventricular tachycardia. Regular tachycardia. If tachycardia immediately decreases to normal, then paroxysmal atrial tachycardia is the most likely condition. Do not massage both sides simultaneously or massage for more than 5 seconds.įindings in specific settings. Following are findings of carotid sinus massage in specific settings: Massage the left carotid artery to affect the atrioventricular (AV) node massage the right carotid artery to affect the sinus node. Massage the pulsation for 3-5 seconds by pushing in and back to compress the artery. Gently palpate the carotid pulse just below the angle of the jaw. If carotid massage can be safely done, have the supine patient turn the head gently away from the side to be massaged. Also be very cautious in patients older than 85 years. Carotid sinus massage is contraindicated if there is evidence of previous cerebrovascular disease and in the presence of carotid bruits. Carotid Sinus MassageĬarotid sinus massage is useful to know how to perform, but it is even more important to know when not to perform it. Having the patient hold their breath for 20 seconds should increase an internal bruit and decrease an external bruit. Hyperventilation increases the external bruit and decreases the internal one. The pulse should be taken for at least 5 seconds to be sure of its absence.To determine an internal from an external bruit, compress the facial and temporal arteries - this increases an internal carotid bruit and decreases an external one. The absence of a pulse (central/carotid) means that cardiac arrest has occurred.In emergency situations the central pulse (carotid pulse) should be taken first, as this does not disappear under low blood pressure conditions.Slide your fingers to the depression near to it That is why the peripheral pulse should only be used in people who are well. on fainting), and this can lead us to think that the heart has stopped. The peripheral pulse disappears when the blood pressure or arterial pressure is low (e.g. If the area where the pulse is taken is near to the heart, the pulse if central (e.g. When the point where the pulse is taken is far from the heart, we are taking a peripheral pulse (e.g. There are different points where the pulse may be taken. The index finger is used to press the artery against the bone, using the middle finger to perceive the pulse. The pulse should be taken with two fingers: the index and middle fingers. When the pulse is weak, fast (more than 120 beats per minute), or is not rhythmical, this is a sign that something is failing in the circulatory system. The normal resting heart rate in an adult is 60 -Ĩ0 beats per minute. If we take the number of beats in one minute, we shall know the heart rate. The pulse must be regular and rhythmical and be perceived to have a certain intensity. The pulse is a vital sign that provides information on the circulatory system and the functioning of the heart.
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