How to Palpate Facial Pulses
Facial pulses are not routinely palpated in standard vascular examination, as the face receives blood supply from branches of the external carotid artery that are too small and deeply situated to be reliably assessed by palpation.
Standard Pulse Examination Sites
The established vascular physical examination does not include facial pulse palpation. Instead, focus on these key pulse sites 1:
- Upper extremity pulses: Brachial, radial, and ulnar arteries
- Lower extremity pulses: Femoral, popliteal, dorsalis pedis, and posterior tibial arteries
- Central pulses: Carotid arteries in the neck
Pulse Palpation Technique
When palpating any pulse, use the following standardized approach 1:
Rating System
Rate pulse intensity numerically 1:
- 0 = Absent
- 1 = Diminished
- 2 = Normal
- 3 = Bounding
Technical Considerations
- Timing: In emergency situations, radial pulse identification is most rapid and reliable—98% identified by 5 seconds and >99% by 10 seconds 2
- Carotid pulse: Requires 10 seconds to achieve >95% identification rate 2
- Reliability: Pulse palpation has significant limitations, with misdiagnosis rates exceeding 30% even among experienced clinicians 3
- Accuracy: Agreement among examiners is only fair to good (kappa 0.38-0.68), particularly in busy clinical settings 3
Relevant Facial Vascular Assessment
For patients with potential circulatory issues or on anticoagulation, assess the face through 1:
- Inspection: Examine for skin color, temperature, and integrity
- Auscultation: Listen for bruits over the carotid arteries in the neck (not the face itself)
- Bilateral blood pressure: Measure in both arms to detect subclavian artery stenosis, which may affect facial perfusion 1
Critical Pitfall
Do not attempt to palpate facial arteries as a diagnostic maneuver. The temporal artery (superficial temporal branch of external carotid) can sometimes be palpated anterior to the ear, but this is primarily relevant for suspected temporal arteritis in elderly patients, not for routine circulatory assessment 1. For vascular evaluation in patients with circulatory concerns, focus on the standardized pulse examination sites listed above and supplement with objective vascular testing such as ankle-brachial index when indicated 1.