SuperFantasticB
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I find it difficult to find the ulnar pulse; when I do locate it I lose the pulse after a few beats. I was hoping for some good advice.
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shiggydiggy
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I think everyone finds it difficult to locate. It isn't the easiest to feel.

Why do you need to?
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SuperFantasticB
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We've got a practical exam coming up soon, which includes finding and counting various pulses. The ulnar pulse has come up a few times in the previous years.

I could possibly get away with being unable to find it but was just wondering if there are any good techniques for finding it.
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shiggydiggy
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Really?! Ulnar?!

I would just pretend in an exam situation, tbh.

Detecting pulses sounds ridiculously simple but it's just one of those things that comes with practice. As long as you're feeling in the right location, there isn't really a trick to it.
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hoonosewot
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(Original post by shiggydiggy)
Really?! Ulnar?!
Ulnar pulse is actually fairly important as you're meant to feel for it every time you do an ABG. Theory being that you don't want to mess with someones radial artery if the ulnar is already compromised.

It is a sod to feel sometimes though, i tend to go very close to the wrist where it's most superficial, then find the most ulnar sided tendon in the wrist and palpate the medial aspect of that. Also if you dorsiflex the wrist that seems to push the artery closer to the surface.

Practice doing that on yourself and you'll find it.
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shiggydiggy
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(Original post by hoonosewot)
Ulnar pulse is actually fairly important as you're meant to feel for it every time you do an ABG.
This never happens.
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nexttime
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Worst. Exam. Ever.
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member327593
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(Original post by shiggydiggy)
This never happens.
Lol if you don't do it in an exam - and ABGs often comes up, you get a straight fail
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carcinoma
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(Original post by hoonosewot)
Ulnar pulse is actually fairly important as you're meant to feel for it every time you do an ABG. Theory being that you don't want to mess with someones radial artery if the ulnar is already compromised.

It is a sod to feel sometimes though, i tend to go very close to the wrist where it's most superficial, then find the most ulnar sided tendon in the wrist and palpate the medial aspect of that. Also if you dorsiflex the wrist that seems to push the artery closer to the surface.

Practice doing that on yourself and you'll find it.
No one feels for the ulnar, you do Allen's test for ABG anyway.


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hoonosewot
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(Original post by carcinoma)
No one feels for the ulnar, you do Allen's test for ABG anyway.


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We were told we should do Allen's, but that if we were rushed (aka always) we can just feel for ulnar pulse and that's OK.

But yeh, in reality no-one EVER does Allen's on the ward, and only the occasional F1 checks the ulnar. I personally do because i'm paranoid, and i'm on Vascular for my first rotation so it's probably good practice to be safe with all the vasculopaths i'll be dealing with.

Also if you're being examined on it, just diving in without doing one of them is probably going to bite you on the bum.
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Captain Crash
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(Original post by hoonosewot)
We were told we should do Allen's, but that if we were rushed (aka always) we can just feel for ulnar pulse and that's OK.

But yeh, in reality no-one EVER does Allen's on the ward, and only the occasional F1 checks the ulnar. I personally do because i'm paranoid, and i'm on Vascular for my first rotation so it's probably good practice to be safe with all the vasculopaths i'll be dealing with.

Also if you're being examined on it, just diving in without doing one of them is probably going to bite you on the bum.
Hypothetical question - you have a clear clinical need (e.g. exacerbation of COPD) to do an ABG. The patient in question fails the Allen's test has no palpable ulnar artery on both arms. Are you not going to do the ABG on the radial artery as a result?
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hoonosewot
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(Original post by Captain Crash)
Hypothetical question - you have a clear clinical need (e.g. exacerbation of COPD) to do an ABG. The patient in question fails the Allen's test has no palpable ulnar artery on both arms. Are you not going to do the ABG on the radial artery as a result?
Good question. I suppose i'd check with a senior to see if a VBG/CBG would suffice or if there's anywhere else i can get it from, but ultimately if put on the spot i'd do the ABG anyway as the chance of thrombosing the radial artery is pretty small. Depends how crucial the ABG is really though.
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Captain Crash
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(Original post by hoonosewot)
Good question. I suppose i'd check with a senior to see if a VBG/CBG would suffice or if there's anywhere else i can get it from, but ultimately if put on the spot i'd do the ABG anyway as the chance of thrombosing the radial artery is pretty small. Depends how crucial the ABG is really though.
Well, if you require an ABG to see the gases (as in COPD) you'll need an ABG. Alternatives to a radial include brachial or femoral (if you feel confident). However, both are end arteries and thrombosing them has the similar (if not worse) consequences as an non collaterallised radial artery.

What I'm trying to say is that an Allen's test is fairly pointless because it doesn't really alter what you do if your ABG is justified.
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hoonosewot
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(Original post by Captain Crash)
Well, if you require an ABG to see the gases (as in COPD) you'll need an ABG. Alternatives to a radial include brachial or femoral (if you feel confident). However, both are end arteries and thrombosing them has the similar (if not worse) consequences as an non collaterallised radial artery.

What I'm trying to say is that an Allen's test is fairly pointless because it doesn't really alter what you do if your ABG is justified.
Yeh that's fair enough, i take your point.

I think the "if justified" is where it becomes useful though. I think a failed test might put off some seniors from requesting the ABG in cases where it isn't essential.

As i said, i don't actually do Allen's anyway, but i don't see the harm in doing a quick ulnar pulse check.
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Alex D
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(Original post by hoonosewot)

It is a sod to feel sometimes though, i tend to go very close to the wrist where it's most superficial, then find the most ulnar sided tendon in the wrist and palpate the medial aspect of that. Also if you dorsiflex the wrist that seems to push the artery closer to the surface.
That is actually top advice, just found mine on the first attempt. Cheers mate!
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squeakysquirrel
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It sounds a bit bizarre - but if you close your eyes too - you are less distracted. Also use all your fingers and press quite firmly. I have never had a problem finding it.
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Sambo2
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#17
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(Original post by SuperFantasticB)
I find it difficult to find the ulnar pulse; when I do locate it I lose the pulse after a few beats. I was hoping for some good advice.
roll your finger to the radial side of the pisiform bone - then it's actually not too hard to find.
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