When Should You Be Checking For a Pulse?
The pulse check has long be a big part of basic life support (aka CPR) classes and training. Only until recently has this been brought into question re-evaluated and made a bit confusing for some. Do we as care providers still check the pulse of the unresponsive victim? The answer is both yes and no. For health care providers taking the professional level basic life support class that answer will be yes. However, the pulse check does not have the same preeminence as it has had in the past.
I do want to point out that consistent breathing is always a better indicator of a working heart than checking the pulse. When the heart fails to pump, respirations also fail. It is possible to look for a pulse and be unable to locate it, even if the patient is breathing. This can be due to poor circulation, inadequate blood pressure or it can simply mean that the provider is not checking for the pulse in the right place. However, when you have an unresponsive patient presenting with consistent breaths, you have a working heart. How you proceed from that point will depend on your individual circumstances, provider care level, availability of equipment, facilities, and so forth.
Healthcare provider level BLS courses instruct professionals responders to check for a pulse on every unresponsive patient. Note however that health care providers also check the pulse on every conscious patient as well when doing an assessment. Checking the pulse is part of checking vitals signs which is what we as professionals are expected to do in order to gain necessary information needed prior to making treatment decisions. Not only are we interested in the existence of a pulse, we are interested in the rate and quality of the pulse as part of our evaluation.
Those who are required to have CPR training but are not professional responders are not expected to perform at this level. For this reason, community level CPR classes instruct students to go directly to CPR if the unresponsive adult victim has no breathing and no signs of life. In most cases, nor breathing and no signs of life mean not pulse. There are some exceptions, but finding an unresponsive victim with a pulse and no breathing is not very common. There is a very small window of time (just a few minutes) until the heart will also stop which means the pulse will cease.
For community level (also called lay responders) providers who are faced with caring for an unresponsive infant or child checking the pulse will be necessary. Children are unlikely to suffer “sudden” cardiac arrest as in adults. They simply haven’t been around log enough to have heart disease which is the leading cause of heart failure. More commonly children stop breathing first before they go into heart failure. They more commonly choke, suffer from a reactive airway disease like asthma or anaphylaxis, the may drown or become unresponsive as a result of trauma or poisoning. Whatever the reason, the probability of finding an unresponsive victim with no breaths and a pulse is higher with children then it is with adults.
Where do you check the pulse in an unresponsive victim? With infants (under 1) the best place is in the brachial artery under the bicep of either arm. With children over 1 and adults, the preferred location will be the carotid artery on either side of the either side of the adams apple.