A pulse check is a rapid assessment of circulation, a fundamental step in emergency response to determine if cardiopulmonary resuscitation (CPR) is necessary. The speed and accuracy of this action are paramount because every second of delay in starting chest compressions decreases the chance of survival. Current guidelines provide a clear, narrow window for this assessment, prioritizing the immediate start of life-saving interventions. This evaluation helps a rescuer decide whether the heart is pumping blood effectively or if immediate intervention is required.
Recognizing the Need for a Pulse Check
The need to check for a pulse arises when a person is unresponsive and not breathing normally. Initial assessment involves checking for responsiveness by gently tapping the person and shouting, “Are you okay?” If there is no response, the next step is to activate the emergency response system immediately.
Following the call for help, the rescuer looks for normal breathing, observing the chest for movement. Abnormal or absent breathing, including gasping or agonal breaths, should be treated as a sign of cardiac arrest. If the person is responsive and breathing normally, a pulse check is not required.
The pulse check is reserved for an unresponsive person who is not breathing or is only gasping, indicating potential circulatory collapse. The purpose is to confirm the absence of a heartbeat before initiating chest compressions, which are a forceful intervention. This decision triggers the subsequent steps of the Basic Life Support algorithm.
Standard Duration and Adult Technique
The standard duration for checking a pulse is strictly limited to prevent a delay in starting CPR. Rescuers must feel for a pulse for a minimum of five seconds but for no more than ten seconds. Prolonged checking uses up precious time when oxygenated blood is not reaching the brain and other vital organs.
For an adult, the preferred site is the carotid artery in the neck. This major vessel supplies blood to the brain, and a pulse here is usually detectable even when blood pressure is low. To locate it, the rescuer places two or three fingers in the groove between the windpipe and the large muscle on the side of the neck closest to them.
Using the fingertips, not the thumb, the rescuer presses gently for the full five to ten seconds. The thumb has its own strong pulse, which can lead to misinterpreting one’s own heartbeat as the victim’s. If the rescuer cannot definitively feel a pulse within the ten-second window, they must assume cardiac arrest and begin chest compressions immediately.
Differences in Checking Infants and Children
The critical time frame of five to ten seconds remains the same for all age groups, but the physical location changes for pediatric patients. The carotid artery in an infant’s neck may be difficult to locate or may be compressed too hard, leading to inaccurate assessment.
Infants (Less than One Year Old)
For infants, the most accessible and reliable location is the brachial artery. This artery is found on the inside of the upper arm, between the shoulder and the elbow. The rescuer uses two or three fingers to press gently in the center of this area to feel for the pulse.
Children (One Year to Puberty)
For a child, the carotid artery can be used, similar to an adult, or the femoral artery may be utilized. The femoral pulse is located in the inner thigh, in the crease between the hip bone and the pubic bone. This alternative site is often more easily accessible than the carotid in a smaller child.
The Critical Next Step After Checking
Once the pulse check is completed within the maximum ten-second limit, the rescuer must transition immediately to the next action based on the finding. This step determines whether the patient receives oxygenation or mechanical circulation. It is also important to ensure that emergency medical services have been activated.
If a pulse is definitely present, but the person is not breathing or is only breathing abnormally, the rescuer should begin rescue breathing. For an adult, this involves giving one breath every five to six seconds while continuously monitoring the pulse. If the pulse is absent or the rescuer is uncertain, the next action is to immediately begin high-quality chest compressions.
Chest compressions are the first component of CPR when there is no pulse, requiring the rescuer to push hard and fast in the center of the chest. Any uncertainty about the presence of a pulse should lead to the immediate initiation of compressions, rather than wasting time with a second check. This rapid shift from assessment to intervention minimizes the interruption of blood flow to the brain.