When encountering an unresponsive victim, the immediate assessment of circulation is a fundamental step in emergency response, guiding the decision to initiate cardiopulmonary resuscitation (CPR). A pulse check quickly determines if the heart is circulating blood effectively. It acts as a gatekeeper for starting chest compressions, which are necessary to manually pump blood in the absence of a heartbeat. This time-sensitive procedure must be executed precisely and efficiently to minimize delay in delivering life-saving interventions.
Establishing the Need for Assessment
The process begins by confirming the victim’s lack of consciousness and assessing their breathing status. A rescuer should attempt to elicit a response by gently tapping the victim and shouting a question like, “Are you okay?” If there is no reaction, the emergency response system must be activated immediately. The rescuer must also look for signs of normal breathing, observing the chest for clear rise and fall. The absence of normal breathing, or the presence of only gasping, indicates a respiratory problem that often accompanies cardiac arrest. The pulse check is only warranted once unresponsiveness and abnormal or absent breathing have been established.
Identifying the Primary Pulse Site
For an unresponsive adult, the preferred location for checking the pulse is the carotid artery in the neck. This site is chosen because the carotid arteries, situated on either side of the windpipe, are major vessels supplying blood directly to the brain. In a state of shock or cardiac compromise, the pulse may disappear in peripheral sites like the wrist or the elbow before it fades in the carotid artery, making the neck a more reliable location for assessment. To locate the carotid pulse, the rescuer first finds the trachea (windpipe) in the center of the neck. The index and middle fingers are then placed on this central structure and slid into the soft groove beside it, between the trachea and the large muscle running down the side of the neck. Applying light pressure in this groove allows the rescuer to feel the rhythmic pressure wave of the arterial pulse.
Execution of the Pulse Check
The pulse check is strictly governed by a specific time frame to prevent delays in starting chest compressions. The rescuer must check for a pulse for no less than 5 seconds and no more than 10 seconds. This minimum time ensures an adequate period to detect a slow or faint heartbeat, while the maximum limit prevents a dangerous interruption of blood flow if the victim is in cardiac arrest. The technique requires the use of the index and middle fingers to palpate the artery, avoiding the use of the thumb. The thumb has its own strong pulse, which could be mistakenly interpreted as the victim’s pulse, leading to a false assessment. Moderate pressure should be applied; pressing too hard can compress the artery, obscuring a genuine pulse, or even trigger a reflex that slows the heart rate. Failing to detect a definite pulse within the 10-second window requires immediate action.
Action Based on Findings
The outcome of the 10-second assessment dictates the course of action in the resuscitation sequence. There are two primary findings. If a clear, definite pulse is present, but the victim is not breathing normally, the rescuer should initiate rescue breathing, providing one breath every 5 to 6 seconds for an adult. Conversely, if the rescuer does not feel a pulse, or is uncertain whether a pulse is present within the 10-second window, they must immediately proceed to chest compressions, initiating CPR. Current emergency guidelines emphasize that the risk of performing chest compressions on a victim who does not need them is significantly less than the risk of withholding compressions from someone in cardiac arrest. The immediate transition to compressions is paramount to maintaining cerebral and coronary blood flow until advanced help arrives.