· Pulses (e.g., examination, grading of)

· A satisfactory pulse can be taken radially in children older than 2 yrs old
· In infants and younger children the
apical pulse is more reliable
· Count the pulse for 1 full minute in infants and young children b/c of possible irregularities in rhythm
· When frequency apical pulses are needed, use shorter counting time (15-30 sec intervals)
· Pulses may be graded according to criteria look at table:
Grading of Pulses below
· Compare radial and femoral pulses at least once during infancy to detect the presence of circulatory impairment, such as coarctation in the aorta
· (Absent femoral pulses associated with coarctation of the aorta)

How to determine the location of apical impulse:
· Just lateral to the left midclavicular line (LMCL) and 4th intercostals space (ICS) in children over 7 yrs of age
· At the LMCL and 5th ICS in children less than 7 yrs of age

Location of pulses include: Picture on page 146
· Carotid
· Apical
· Brachial
· Radial
· Femoral
· Popliteal
· Posterior tibial
· Dorsalis pedis

Grading Of Pulses
Not palpable
Difficult to palpate, thread, weak, easily obliterated with pressure
Difficult to palpate , may be obliterated with pressure
Easy to palpate, not easily obliterated with pressure (NORMAL)
Strong, bounding, not obliterated with pressure