unequal pulses

[PCP]

Good evening to you all. Hope everybody is having a great weekend!

I have a quick question which I know I could look up on Google but I would rather learn from the experts! I did attempt to locate the answer in my text but had no luck.

I had a patient the other day who fractured his hip. During my secondary survey on the way to the hospital I checked both radials and I found one was VERY weak and the other side was Bounding.

My initial thought was there might be a partial occlusion somewhere within the artery? I checked both Brachial arteries and they were both strong and regular.

I am not sure but I am going to take a guess at this one. If there was a partial occlusion within the artery it would prevent blood flow distal to the occlusion causing the pulse to be weaker due to the decreased blood flow to the radial pulse.

When I mentioned my findings to the nurse she checked and compared the pulses she came up with the same findings but could not explain why the difference between the two radial pulses.

If there was an occlusion whithin the arm would it make it difficult to get a Blood pressure reading?

Any Ideas?

Brian

[systemet]

A partial occlusion along the brachial artery would explain the finding, but is somewhat unlikely. A major concern in this situation is the presence of a thoracic aortic aneurysm. If the aneurysm affects flow to the right arm (typically via the right subclavian branching off the brachiocephalic trunk) or to the left arm (via a left subclavian branching directly of the thoracic aorta), then the pulse on the corresponding side will weaken).

This is similar to the finding of unilaterally (or bilaterally) diminished pedal or femoral pulses in an abdominal aortic aneurysm.

A tumor in the thoracic cavity could cause similar symptoms.

If this is an elderly patient, it's possible that their physician is aware that some form of obstruction is present, but surgical repair/treatment may be contraindicated.

[BushyFromOz]

Any history of by-pass surgery?

[PCP]

The patient was 91 years old, so yes it is possible that a physician is aware that some form of obstruction is present. Now I had a chance to check up on my patient later in the day, and he was scheduled for surgery the next to fix his broken hip.

I should have added as well that I spoke to the nurse again about an hour later and she mentioned that when she check the pulses again that they where both equal, strong, and regular.

Any history of by-pass surgery?

zero hx of a by-pass surgery. The pt. did have a cardiac hx but I can't think of what his condition was at this time.