15 September, 2011
How to Feel a Pulse Between the Ribs
Just slightly larger than your fist, the human heart sits in the middle of the chest, just behind the ribcage and between the lungs. The heart sits upside down in the chest. The base of the heart is actually at the top, while the heart's apex is at the bottom. Locating the area of the heart’s apex on the chest wall allows you to feel for the apical pulse. With each contraction of the heart, you can feel the pulse gently tap between the ribs.
Ask the person to sit or lie down. Either position allows the apical pulse to be felt more easily.
Count the ribs on the person’s left side, beginning at the top. Do not count the collarbone as your first rib; it is not a rib. As you move toward the bottom of the ribcage, you’ll need to move your fingers toward the side of the body to feel the lower ribs. You should feel 12 ribs on the left side.
Re-count the ribs starting at the top. This time, stop once you reach the fifth rib. If you are just learning, you might wish to use a pen with non-toxic ink to make a small mark on the skin over the fifth rib.
Move your fingers up and locate the fourth rib again. If necessary, make a small mark on the skin over the fourth rib as well.
Slide your fingertips into the space between the fourth and fifth ribs. Since there are no bones underneath this area, you should be able to gently press your fingers into the area. This entire area between the fourth and fifth ribs is called the fifth intercostal space.
Find the sternum, the long bone that extends directly down the front of the chest. This bone connects the left and right sides of the ribcage.
Measure about 7 to 9 inches away from the sternum into the fifth intercostal space on the left side of the person’s body. If you lack a measuring device, the palm of your hand may be about 7 to 9 inches wide. This area -- about 7 to 9 inches from the sternum in the fifth left intercostal space -- is the location of the heart's apex. This is where you listen or feel for the apical pulse.
Press the pads of your index and middle finger gently into this area. You should feel the pulse tapping against your fingers. When counting the apical pulse, count the number of times the pulse taps against your fingers for 60 seconds.
Roll the person slightly to the left if you have a difficult time feeling the apical pulse. This re-positioning brings the heart closer to the chest wall.
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