In patients with carotid obstruction, kinking, or thrills, assess the pulse in the brachial artery, applying the techniques described previously for determining amplitude and contour.

The patient's arm should rest with the elbow extended, palm up. Cup your hand under the patient's elbow or support the forearm. You may need to flex the elbow to a varying degree to get optimal muscular relaxation. Use the index and middle fingers or thumb of your opposite hand for palpation. Feel for the pulse just medial to the biceps tendon (Fig. 1).

FIGURE 1. Palpate the brachial pulse.

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