pulse in one extremity is unequal in strength or absent. Assessment of all symmetric pulses simultaneously is acceptable, except for the carotid pluse.Never measure both carotid pulses simultaneously because excessive pressure has potential to occlude blood supply to the brain. Do not reach across the patient's neck to count the carotid pulse(the patient's airway can be occluded with the pressure of your arm). Measure the carotid pulse in the patient's neck on the side facing you.