Let us begin the evaluation of our patient by taking their blood pressure. I shall place the diaphragm of the stethoscope on the brachial artery, pump up the cuff to greater than the systolic level, and we shall all observe and listen together. I now deflate the blood pressure cuff [Korotkoff sounds].
Our patient’s blood pressure is 90/60. Don’t forget, that could be normal for this patient, we don’t know the patient’s blood pressure prior to this event. But be alert, be alert, it could be telling us that there is a complication here. Two things come to mind immediately: maybe the patient is hypovolemic or maybe the extent of this infarct is significant and the blood pressure reflects significant left ventricular dysfunction.
Carotid pulse presentation
Next, we shall evaluate our patient’s arterial pulses. The carotid vessel, just medial to the sternocleidomastoid in the neck, and the peripheral pulses, brachials, radials, and femorals. Now, light pressure on that carotid vessel reveals to me that it is entirely normal. And i’d like to share that with you by placing a cotton swab on the vessel and as we watch the excursion of the tip of the cotton swab, we see that it is normal.
You know, it isn’t always normal, it could be reduced, and when it is, it may be a clue, a clue to reduced ventricular function. So, carefully palpate that carotid vessel.
And the peripheral vessels? They can also give you clues to a diagnosis. You must palpate them bilaterally, and it there’s a difference, you might consider dissecting aneurysm with or without infarction.