1. Rate
2. Rhythm
3. Character
4. Delays
5. Surface anatomy of pulses

Rate

• <60: bradycardia
• >100: tachycardia

Rhythm

• Regular
• Regularly irregular
• Irregularly irregular

Character

• Bounding pulse:
  • CO2 poisoning
• Collapsing pulse, aka 'water hammer pulse':
  • Aortic regurgitation
  • Heart block
  • PDA 
• Plateau pulse:
  • Aortic stenosis
• Pulsus alterans [alternate strong, weak beats]:
  • LVF
• Pulsus paradoxus [volume decreases on inspiration more than normal: by >10mm Hg]:
  • Constrictive pericarditis
  • Tamponade
  • Severe asthma
• Small volume:
  • Aortic stenosis
  • Shock
  • Pericardial effusion

Delays

• Radioradial delay
• Radiofemoral delay: test in pts with HTN or ejection systolic murmur:
  • Coarctation of aorta

Surface anatomy of pulses

• Radial
  • Palmar side of wrist, between flexor carpi radialis tendon and radius.
• Brachial
  • Cubital fossa, medial to biceps tendon.
• Carotid
  • Just lateral to upper border of thyroid cartilage.
• Superficial temporal:
  • Anterior to ear as crosses temporal bone's zygomatic process.
• Abdominal aorta:
  • In midline, at umbilicus pressing into abdomen.
  • Use caution if large AAA, to avoid rupture.
• Femoral
  • Below inguinal ligament, midway between ASIS and pubic symphysis [not pubic tubercle].
  • May be reduced or absent in arteriosclerotic dz.
• Popliteal
  • Flex knee before palpating.
  • In midline, on popliteal side of lower end of femur.
  • Most difficult one to palpate.
  • Alternative method: Dr's one hand on pt's knee, other hand under knee. Push flexed knee downwards [into extension] until can feel popliteal.
• Posterior tibial
  • Posterior, inferior to medial malleolus, between flexor digitorum longus and flexor hallucis longus.
• Dorsalis pedis
  • Lateral to extensor hallucis longus, over tarsal bones.
  • Palpate with 3 fingers along artery.
  • May be reduced or absent in peripheral vascular dz.
• For JVP, See JVP Reference.