palpation minute: right-hand man physician
situated in the ideal iliac area
so that the ideas of your bent fingers
were 1/3 of the range from spina
to the navel.
palpation minute: throughout motivation by motion
explorer’s hands towards
navel kind a skin fold.
palpation minute: throughout exhalation,
making the most of stomach muscle relaxation
press, look for as deep as possible
immerse the fingers of the right-hand man in the stomach
cavity till reaching its posterior wall.
palpation minute: at the end of exhalation do
rolling movement e in the instructions
and get palpation
about the cecum.
generally the cecum is smooth
soft flexible cylinder size
2-3 cm. It is rather broadened downward,
where blindly ends with rounded
upside down. The gut is pain-free, reasonably
movable, rumbling with pressure.
and coming down colon
palpated utilizing bimanual
palpation. To develop a strong structure
the left hand is put on the lumbar
location on the right and left. Fingers right
hands set perpendicularly
axis of the rising or coming down intestinal tract.
Gliding immersed in the stomach
the cavity is performed by the fingers outside.
Palpation of the transverse colon
invest 2-3 cm listed below the discovered border
stomach, or with one right-hand man, very first
setting it to 4-5 cm to the right of the middle
lines, then left or bimanually
– setting the fingers of both hands on the right and
left of the midline. what
relating to penetrating rising and
coming down gut then all over
throughout these areas of the colon
palpated seldom and palpable
with problem, considering that they lie
on a soft lining, that makes it hard to produce
However, in those cases
when these departments are altered in impact
any pathological procedures in
themselves (inflammatory thickening
walls, ulcers, established neoplasm,
polyposis) or lower, e.g. with constricting in
location fl. hepatica or in SR which requires
hypertrophy and thickening of the wall
of these departments, used by basic
palpation guidelines enables
not just simple to penetrate these departments
coli, however likewise by particular palpation
detect the matching
Inspection of the liver. Palpation of the liver.
The series of actions of a physician with
palpation of the liver. Edge function
liver and its surface area. Changes
liver pathology (specified
physically). Clinical significance
the liver is produced according to the guidelines of deep
moving palpation according to Obraztsov. Doctor
situated to the right of the client,
supine with lengthened
upper body with arms and knees bent
feet on the bed.
Prerequisite – optimum
muscle relaxation of the stomach wall
client with deep breathing.
boosted liver adventures ought to
utilize palm pressure left
physician’s hands on the lower parts of the front
chest wall on the right. Palpating
the right hand lies on the anterior abdominal
the wall below the edge of the liver (which follows
while the fingertips (they ought to
put along the intended
lower edge) plunge deep into the abdomen
synchronously with the patient’s breathing and
another deep breath meet
with a falling edge of the liver, from under
which they slip out.
severe ascites normal percussion and
palpation of the liver is difficult, therefore
utilize the ballot palpation method,
revealing the symptom of “floating
ice floes. ” For this, the right brush is placed
in the mesogastric region, lower right
belly button and jerky movements
fingers move up to
sensations of a dense displaced organ
under the fingers. With this technique
can get an idea of
features of the edge of the liver and its surface.
using palpation of the liver above all
evaluate its lower edge – shape,
sensitivity. Normal edge of the liver
on palpation of a soft consistency,
smooth, pointed (thin), painless.
Displacement of the lower edge of the liver may be
associated with the omission of an organ without it
increase; in this case shifts
down and the upper border of the hepatic
If a person feels that something is happening with his pulse that does not fit into the framework of the ordinary, he begins to check his frequency on his own, that is, by palpation. To do this, just attach two fingers (middle and index) to the place where the pulsating walls of the capillaries and veins are most clearly audible.
Such places include the wrist, the chest area, where the heart, neck, and temple are located. As soon as you hear the first characteristic impulse, you need to detect a time equal to 60 seconds. According to the results of a simple experiment, which tactfully demonstrates what pulse a person has at the moment, it is possible to detect disorders in the cardiovascular system or to be relieved to understand that there are none.
- The main signs of a pulse
- Specific features of the violation
- Pulse study
- Related Images
- Concept of heart failure
- Causes of the pulse rhythm phenomenon
- 29. Deep methodical sl >Deep methodical sliding palpation along V.P. Obraztsov allows you to probe intestines and stomach. Technique deep palpation includes four method – setting the brush over the projection palpable intestinal tract, set of skin folds, immersion in expiratory abdominal area, gliding when holding your breath.
- Abnormal vascular development
The main signs of a pulse
When examining a pulse, one determines its characteristics:
- Uniformity on both hands
Heart rate is the number of pulse waves in 1 minute. In a healthy person, the number of pulse waves corresponds to the number of heart contractions and is 60-90 in 1 min. A heart rate of more than 90 is called tachycardia, and a heart rate of less than 60 beats per 1 minute is called bradycardia. The occurrence of tachycardia, bradycardia and arrhythmia requires careful monitoring of the patient, especially if these signs appear in the patient for the first time. Under physiological conditions, the pulse rate depends on many factors:
- from age (frequent pulse in the first years of life);
- physical work during which the pulse accelerates;
- from the floor (in women, the pulse is 5-10 beats per minute more often than in men);
- from the influence of emotions (with fear, anger, the pulse quickens)
- from training (in a trained heart, the pulse is rare)
The cause of an accelerated pulse may be an increase in body temperature. An increase in body temperature by 1 ° C causes an increase in heart rate by 8-10 in 1 min.
The rhythm of the pulse is evaluated by the regularity of the appearance of pulse waves. If they appear at regular intervals, then the rhythm is considered correct (rhythmic pulse). At various intervals between the pulse wave, the pulse rhythm is called abnormal (arrhythmia).
Some contractions are so weak that the pulse wave does not reach the peripheral arteries and is not detected by palpation.
Pulse deficiency – when the number of pulse waves becomes less than the heart rate. Therefore, it is not enough to count the pulse on the radial artery, but it is necessary to calculate the number of heart contractions. The difference between these two indicators determines the deficiency of the pulse
Alternate pulse – alternating weak and strong pulse waves, a sign of severe damage to the cardiovascular system.
Pulse voltage refers to the degree of resistance of the finger artery. It is determined by the force with which you need to press the artery wall to stop the pulsation. The degree of pulse voltage depends on the level of blood pressure: when it increases, the pulse becomes hard or tense (the vessel is difficult to squeeze), when it decreases, it becomes soft (when the blood pressure decreases, it is easy enough to press the artery as the pulse disappears).
The filling of the pulse is the degree of filling of the artery with blood during systole of the heart. It depends on the amount of cardiac output, that is, on the amount of blood that the heart ejects blood vessels during its contraction. With good filling, a significantly higher pulse wave under the fingers, and with poor filling, small pulse waves.
A filamentous pulse is a frequent, barely perceptible pulse.
Arrhythmia is most often a manifestation of a disease of the heart muscle, the conduction system of the heart, a violation of the nervous regulation.
Extrasystolic arrhythmia – between two successive contractions of the heart, an additional systolic (extrasystole) occurs. The pause provided by the extrasystole is called a compensatory pause and is much longer than the usual one. Extrasystoles can be single or group. In some diseases, attacks of extrasystolic tachycardia occur, lasting from several seconds to several days. These seizures are called paroxysmal tachycardia.
Atrial fibrillation – characterized by the absence of any regularity of rhythm and filling of the pulse. This arrhythmia is a consequence of severe myocardial damage (heart disease, atherosclerosis, hyperthyroidism). Very often with atrial fibrillation, a so-called pulse deficiency develops, in which not all heart contractions push enough blood into the arteries.
P wave before
each QRS complex;
– P wave positive
in assignments I, II and
negative in aVR;
and the normal interval P − Q (0,12−0,20
heart rate over 100 beats per minute
significant shortening of the TP interval,
to a lesser extent – PQ interval
oblique ST segment depression
(at a high rhythm frequency).
the presence of a tooth P of sinus origin
Heart rate less than 50, but not lower than 40 beats per minute
TP interval extension
and to a lesser extent the PQ interval.
irregular rhythm (different RR)
fluctuations in the duration of the RR intervals
exceeds 0,15 ,,
P wave more than 0,11 ″ (up to 0,12 ″ or more),
due to the increase in coverage time
(two-peaked, “bumpy”) teeth
with an increase in the amplitude of the second phase in
i.e. in those leads whose axes are more
or less parallel to the left EMF vector
between two vertices of the P wave more
(-) P wave in lead and V1
(less commonly in V2
) with a sharp predominance of the second
(terminal) of its negative phase,
reflecting excitement of the left atrium.
may not be visible (“turns into
point “), because the atrial vector becomes
perpendicular to axis III
Deepening of a tooth of P in assignment of AVR,
since the polarity of this lead
directed in the opposite direction
EMF of the left atrium (wide
bumpy negative P).
the left atrium is the main
(with overload of the left atrium
pressure or volume), especially with
resulting in the above configuration
P wave in standard and chest leads
is called “P mitrale”
The P wave becomes tall, symmetrical,
single-pointed, pointed (“Gothic *”,
as the “roof of the house”) in those leads
which reflect predominantly
potentials of the right atrium, i.e., in
Because the right atrium causes
primary and secondary education
parts of the P wave, with its hypertrophy
the total duration of the P wave is not
(-), then, unlike left hypertrophy
atria, while prevailing
first () phase of this
tooth P with hypertrophy of the right atrium
can be observed not only in V1,
but also in V2,
and in V3,
and sometimes with V1
more pronounced hypertrophy of the right
atria, in large quantities
chest leads are high,
pointed () tooth R.
lead P is flattened or
often negative (-).
with pronounced right hypertrophy
atrial P can
(as indicated above) is characteristic
high, pointed (gothic),
persistent sign of hypertrophy
pointed (Gothic) tooth P in II,
right atrium occurs either
defects of the right half of the heart,
primary pulmonary hypertension, or
more often with
pulmonary diseases are more common
defects of the right half of the heart],
as a result of which the described tooth carries
the name “P
– rulmonale »
Specific features of the violation
If we take one minute as a temporary basis, then the state of the organism at the moment depends on the number of strokes.
- Less than 30 strokes – this indicator may indicate atrioventricular block.
- Approximately 40-60 beats – an alarm bell, indicating a sinus bradycardia or atrioventricular block, accompanied by a nodal replacement rhythm.
- 60-90 beats is a normal rhythm that matches the heart rate.
- 90-159 – tachycardia or atrial fibrillation.
- 160-250 strokes is a very serious symptom, the cause of which can be hidden in paroxysmal atrial or nodal tachycardia, as well as atrial flutter with atrioventricular block.
- 251-350 beats – a rather rare pulse rhythm, indicating atrial flutter with atrioventricular block. Such patients are shown a priori bed rest and inpatient treatment.
Sometimes on one hand the rhythm of the pulse and its strength can be higher (lower) than on the other. This is a signal that the blood flow comes across an insurmountable obstacle for him that can weaken the force of oscillations along the walls of blood vessels and capillaries. Pulse deficiency can be a precursor to the diagnosis of diseases such as enlarged atria or tumor foci.
For diagnostic purposes, the pulse is examined on the carotid, temporal, subclavian, radial, popliteal, posterior tibial arteries. The easiest method to study the pulse is to feel in areas where arteries are located closer to the surface of the body. Of course, the place where the pulse is studied is at the same time points of pinching the arteries to stop arterial bleeding due to the adjoining arterial vessels in the bone at these places.
It is easiest to examine the pulse on the radial artery located superficially and easily palpated between the styloid process of the radius and the tendon of the internal radial muscle. Examining the pulse on the radial artery, the palm is placed above the wrist joint so that the thumb is on the back of the forearm, and the remaining fingers are on the radial artery at the base of the patient’s first finger.
A pulse study begins on both hands. The pulse on the right-hand man is examined with the left and vice versa. Palpation of the pulse is carried out by the second, third and fourth fingers, which moderately press the artery to the inner side of the radius. To determine them, the number of pulse waves is calculated in 2 seconds and the obtained value is multiplied by 1. If the rhythm is incorrect, the calculation is carried out for minute.
Compare the magnitude and synchronism of the appearance of pulse waves in the right and left radial arteries. A different value of pulse waves in these arteries is observed with anomalies in the development, narrowing or retraction of one of the arteries. If there is a difference in heart rate, studies are performed on that radial artery where pulse waves are better.
In addition to the radial artery, the pulse is examined on other vessels. On the carotid arteries, the pulse is examined alternately on each side without strong pressure on the artery. With significant pressure on the carotid artery, a sharp slowdown in cardiac activity is possible, up to cardiac arrest and a decrease in blood pressure. Dizziness, convulsions may occur in the subject.
The pulse on the femoral artery is examined in the inguinal region with the thigh straightened and slightly returned to the outside. On the popliteal artery, the pulse is examined in the popliteal fossa in the position of the patient lying on his stomach. The pulse on the arteries of the dorsum of the foot is palpated on the dorsum of the foot in the proximal part of the first mucosal space.
The results of the pulse study are recorded in the medical history or outpatient card, indicating the rhythm. The pulse rate is noted daily in red pencil on an individual temperature sheet. The connection of the points that correspond to the noted pulse rate is called the pulse curve, with arrhythmia it is depicted by the frizz line.
Concept of heart failure
In addition to the above deviations from the norm, there can be one more that is often found in medical practice. Such symptoms were called “pulse deficiency”, or as it is also called “Jackson’s syndrome.” Defining it yourself is almost impossible. To do this, you need at least two people, one of whom will count the heart rate, and the second – the pulse rate.
If, over a single period of time, heartbeats are more or less than pulse waves, then there is precisely a deficiency of the pulse. Do not immediately sound the alarm and try to treat yourself with all available “grandmother’s means”, including “miraculous” potions and decoctions of herbs. From this moment you need to be especially attentive to your health and try to eradicate the pathology until it has reached alarming proportions and has led to some more brothers in the form of serious diseases of the cardiovascular system.
Causes of the pulse rhythm phenomenon
The main prerequisite for the occurrence of such a mismatch in the human body is the malfunctioning of the heart, when this organ, for whatever reason, performs the duties assigned to it by nature incorrectly, everywhere losing its rhythm.
At the same time, the portions of blood pumped by the main muscle of the body are uneven, their volume is not full. If heart contractions are weak, then pulse deficiency often occurs in persons of different ages and sexes, it can be triggered by the fact that the blood flow is so powerless that it doesn’t reaches capillaries distant from the organ.
29. Deep methodical sl >Deep
methodical sliding palpation along
V.P. Obraztsov allows you to probe
intestines and stomach. Technique
deep palpation includes four
method – setting the brush over the projection
palpable intestinal tract,
set of skin folds, immersion in
expiratory abdominal area, gliding
when holding your breath.
he feels the intestinal tube with his fingers
and evaluates its size, consistency,
mobility, surface area condition,
the presence of soreness.
auscultation of the abdomen in a healthy person
periodic peristalsis is heard
intestines. Normal change
auscultatory picture might be
increased intestinal motility
after eating, especially foods rich in
intestinal motility and loud
rumbling with thin inflammation
intestines (enteritis) of various
peristalsis and rumbling in primary
stages of bowel obstruction;
weakening of intestinal motility
in patients with intestinal atony;
weakening or even absence
intestinal motility in patients with
Abnormal vascular development
You can not discount the genetic abnormalities manifested in the abnormal configuration of the vessels. At the same time, such a characteristic of the pulse will accompany an individual throughout his life or become more pronounced in middle and old age.
Proper nutrition and a lifestyle that meets the canons of health are the 2 aspects that can unrecognizably transform the body of everyone, even if pulse deficiency has actually end up being a constant companion. For a lover of his body there are no barriers, and the huge potential of health is inherent in everybody.
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