pedal pulse

[JaSam]

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Ok I'm not sure how many MSIIIs have trouble with this. But we really had a horrible physical diagnosis exposure at our school the first two years and right now i'm starting my rotation and just petrified to do this. I mean I can find my DP pulse on myself and that's about it. But on patients , no way. And the Post Tibial pulse is like a ghost to me. Anyone have any suggestions or tips? Greatly appreciated.

 

[ShyRem]

DP can vary quite a bit from pt to pt. Some have more proximal, others more distal. Patience, a light touch, and lots of practice.

The PT is a bit more difficult, particularly if your patient has edematous ankles. Again, practice.

Try to locate these on every patient you can. It only takes a few seconds.

 

[pincheeric]

As stated above practice whenever you can. Just feel for the pulses everyday on each patient when you preround by yourself. It will add an extra 2 minutes to your day total. Also, make sure with the DP you don't press too hard. If you do you can extinguish the pulse. If I have trouble finding it I will draw a mental line from the space between big toe and 2nd toe straight up the leg and follow that line. You should be able to find the pulse along there.

 

[persia]

It's definitely a practice thing but you can totally do this. First, just know that these two pulses are there somewhere, place your hand on the top of the foot and wait quietly until something starts to feel like a pulse. Try and visualize the artery map of the dorsum of the foot. Give yourself a minute and don't get nervous.

PT, same thing. It's there somewhere so put your hand in the area just south of the ankle bone (yes, that is the medical name for it) and give it a few seconds. I like to use all my fingers and then just wait until something starts to feel like a pulse. Don't get flustered and don't give up too easily. Remember, your job is to do your exam and if it takes you an extra few minutes then so be it.

Grab one of those portable dopplers when you have a minute and practice on yourself or anyone who will let you. It's a great exam to do and you will master it. 👍

PS-re-reading your post, one thing to remember if you can as you go through third year is that when you feel completely terrified (which is normal), try and stop and step back and say: hey, wait a minute! I am a normal, smart person. I can totally figure this out. Sometimes, the terror of the situation can cloud your otherwise normal thinking. This is hard, but it's advice I found helpful.

 

[jdh71]

DP: Bend the patient's large toe, feel the extensor hallucis longus tendon, place pads of all four fingers just lateral to this tendon half-way between the middle of the foot and ankle . . . *beat* *beat* *beat*

PT: Place your first and second fingers just immediately inferior and posterior of the medial malleolos *beat* *beat* *beat*

FEEL with you fingers pads - DON'T press hard. The pulse comes up to you, not you to it.

 

[Ypo.]

I guess I would also say; don't get discouraged. When I was trying to learn how to do this, I would ask different attendings to show me their technique. On a few occasions, they could only find it on one side or not at all. On some people (as has already been mentioned) you won't be able to find it. (esp the PT).


I'm embarrassed to admit I can only find the optic disc half of the time, and then it's usually only on the patient's right eye.

 

[JaSam]

thanks so much guys . So damn helpful. I greatly appreciate it and I'll keep on trying.
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[RussianJoo]

you can always use a dopler if u can't palpate it.

 

[Tired]

you can always use a dopler if u can't palpate it.

Dopplers are for wimps and vascular surgeons.


When I have trouble finding the DP, I take all my fingers (not just the pads, the whole volar aspect) and set it gently on the dorsal aspect of the foot and wait.

Just wait. Patience is a virtue.

Eventually you'll feel it kick in (most of the time). Then confirm with the pads of your fingers.

Always palpate both sides at the same time in the same way.



(As a side note, I have zero evidence to back this theory up, but I'm convinced that in some people with crappy arterial flow, pressing on the distal arteries causes temporary vasospasm that shuts off the pulse for a few seconds. Plenty of times I will palpate the pulse and feel like one beat, then it disappears for like 5-10 seconds, and comes back.)

 

[vtucci]

I completely sucked at finding the post tib pulses when I started 3rd year. I made the pedal and post. tib pulses part of my exam on every patient (as part of the CV section).

Most of the standardized patients they have us see in the preclinical years had +2 pulses bilaterally. However, in the real world, many patients have 0-1+. It is not that unusual and just takes getting a feel for it.

 

[deleted29780]

you can always use a dopler if u can't palpate it.

hey, why do you learn clinical skills? its an over reliance on imaging techniques and adjunctive investigations which is going to lead to a generation of doctors who are deficient in clinical skills. Its just a general advice and not an attack on the pstr.

 

[jclarke]

A vascular surgery patient had undergone surgery for his peripheral arterial disease. Two other students said they could feel his pedal pulse. I couldn't and we were running out of time. One more student went after me and said he could palpate it. The surgeon on call that Saturday palpated and couldn't feel it either--we got the Doppler and he didn't have adequate flow for a palpable pulse. So, if you don't feel it, you may be right!

PS. the other students were pressing so hard they were feeling their own pulses!

 

[ShyRem]

If the patient's pulse is exactly like your own (you should be in tune to this), you should suspect you aren't feeling theirs. I have yet to take the pulse of anyone and have it exactly in sync with mine.

And this brings up another point - OP you should be commended for not saying "yes" when it's really "gee, I dunno" or "nope, don't feel it". At least you don't look like a liar like in the jclarke case above (I really pity those three other med students - they're going to get a whole lot of crap for that one).

 

[Jimmi]

I agree with what pin said. Definitely, light touch and practice.