Good day!

I am JI Butuyan and today I am

going to demonstrate the palpation of
pulses and tourniquet test. These are the
areas that I am going to palpate today. Note
that we need to count the pulses in 1 full
minute. Before we start, we have to make
sure the child is at rest and not affected by
any activities.

To feel a pulse, you press two fingers — your

index ("pointer") and middle fingers — onto a
major artery in the body. Press gently. Never
press with your thumb, as it has a pulse all its
own and can throw off a reading. When you've
located the pulse, you will feel a throbbing
sensation.

On the neck , the carotid artery runs along either

side of the throat. Run your fingers about
halfway down the neck and press gently to the
left or right side of the windpipe. Press gently.
You should feel the pulse.
o On the wrist (radial pulse). This is the spot
where most adults have their pulse taken but can
work well in kids, too. Place a finger at the base
of your child's thumb and slide it straight down
to the wrist. press gently to feel for the pulse.
o For axillary pulse. Press your fingertips into
the armpit, feeling around for the arm bone.
When you feel the arm bone beneath your
fingers, you should also feel the pulse.
o For brachial pulse. This location works best
for infants. Place your infant on his or her back
with one arm flat along the baby's side . In the
crease of the elbow, gently place your fingers on
the inside of the arm.
o Femoral - The femoral pulse may be the
most sensitive in assessing for septic shock and
is routinely checked during resuscitation.
Palpated distally to the inguinal ligament at a
point halfway from the pubis to the anterior
superior iliac spine.
o Popliteal pulse is present in the popliteal
fossa slightly lateral of the midline.
o Posterior tibial pulse may be the most
difficult to palpate, especially among less
experienced clinicians. It is immediately
posterior to the medial malleolus.
o Dorsalis pedis is at the anterior aspect of the
foot, lateral to the extensor hallucis tendon, and
is generally within 1cm of the bony prominence
of the navicular bone. Asking the patient to
extend their first toe can help elevate this
landmark and may make the pulse easier to
identify.

The tourniquet test is part of the new WHO case

definition for dengue. The test is a marker of
capillary fragility and it can be used as a triage
tool to differentiate patients with acute
gastroenteritis, for example, from those with
dengue. Even if a tourniquet test was previously
done, it should be repeated if
* It was previously negative
* There is no bleeding manifestation
How to do a Tourniquet Test
    1. Take the patient's blood pressure and
record it, for example, 100/70.
    2. Inflate the cuff to a point midway between
SBP and DBP and  maintain for minutes. (100 +
70) ÷ 2 = 85 mm Hg
    3. Reduce and wait 2 minutes.
    4. Count petechiae below antecubital fossa.
    5. A positive test is 10 or more petechiae per
1 square inch.