A pulse check is a rapid assessment performed on an unresponsive individual to determine if the heart is circulating blood effectively. This step is a component of basic life support (BLS) and dictates the subsequent course of action: initiating chest compressions or rescue breathing. Determining circulation is time-sensitive, as delays in providing cardiopulmonary resuscitation (CPR) to a victim without a pulse diminish their chances of survival. The assessment process, from establishing unresponsiveness to concluding the pulse check, must be executed swiftly and methodically.
Prioritizing Safety and Establishing Unresponsiveness
Before approaching an individual in distress, a rescuer must first verify that the immediate area poses no danger to themselves or the victim. The principle of “Scene Safety” ensures the responder does not become a second casualty, preventing the possibility of providing aid. This involves quickly scanning the surroundings for potential hazards like traffic, fire, or unstable structures.
Once the scene is safe, the responder must confirm the person is unresponsive before proceeding with the pulse check. For an adult or child, this is done by gently tapping the victim’s shoulder and shouting, “Are you okay?” An infant’s responsiveness is checked by tapping the sole of the foot. A lack of movement, eye opening, or verbal response confirms the person is unresponsive and requires further emergency assessment.
Identifying the Correct Pulse Location
For an unresponsive adult or child over one year of age, the primary site for a pulse check is the carotid artery, located in the neck. This large vessel supplies blood to the brain, and its proximity to the surface makes the pulse palpable even when blood pressure is low. To locate it, the rescuer first finds the trachea, or windpipe, in the center of the neck.
The fingers are then slid into the groove between the trachea and the sternocleidomastoid muscle, on the side closest to the rescuer. For infants, whose necks are shorter, the preferred location is the brachial artery. This artery is located on the inside of the upper arm, situated between the elbow and the shoulder.
The Proper Pulse Check Technique
The pulse check must be performed using the index and middle fingers, as the thumb has its own strong pulse that can lead to an inaccurate reading. Once the correct artery is located, the two fingers are pressed gently but firmly into the groove. Applying too much pressure can compress the artery and block circulation, which could lead to a false negative result, indicating no pulse is present when one is.
Emergency guidelines stipulate that the assessment must take a minimum of five seconds to allow time to detect a potentially slow or weak pulse. The check must not exceed 10 seconds, as any delay significantly postpones the start of life-saving compressions. Never check both sides of the neck simultaneously for the carotid pulse, as this could restrict blood flow to the brain.
Immediate Next Steps Following Assessment
The result of the pulse check immediately directs the rescuer’s next actions. If a definitive pulse is felt within the 10-second window, the victim is not in cardiac arrest, and the rescuer should focus on breathing. If the person is not breathing normally, the rescuer must initiate rescue breathing, providing one breath every five to six seconds for an adult.
If no pulse is felt, or if the rescuer is unsure after the maximum 10 seconds, the individual is presumed to be in cardiac arrest. The rescuer must immediately begin high-quality chest compressions, starting the cycle of CPR with compressions and rescue breaths. Simultaneously, emergency medical services must be activated, and an automated external defibrillator (AED) should be retrieved and applied as soon as possible.