Carotid Exam

• Auscultate with bell of stethoscope for bruit
• A bruit is described as a “blowing or swishing” sound indicating blood flow turbulence
• Normally no bruit is present
• Lightly apply the bell over the carotid artery at three levels:
  
  1. the angle of the jaw
  2. the midcervical area
  3. the base of the neck
  
  
• Avoid excess pressure when auscultating carotids
• In patients with atherosclerotic carotids pressure can cause false bruit as circulation is compromised in an already narrowed artery
• Ask the patient to hold their breath briefly while listening to diminish interference from tracheal breath sounds
• A bruit usually indicates turbulence due to local vascular cause such as atherosclerotic narrowing
• The loudness of the bruit increases as the lumen narrows
• When the lumen is totally occluded the bruit disappears making the absence of a bruit not necessarily diagnostic of an absence of a lesion