Often it’s the little skills that we overlooked in training that interrupt effective first aid.  In my experience the classic underdeveloped “little skill” is finding pulses.

So here is my run down on how to effectively find and utilize pulses.  However before I start I would like to point out that this is written for lay first responders and, as such, I will dispense with unnecessary detail or distinctions regarding anatomy or clinical findings.  I strongly encourage all my readers to pursue these details if they feel inclined but remember as street medics we aim to empower each other act effectively, not brow beat each other with minutiae.

 Why check pulses?

An effective first responder checks pulses to simply observe their presence and their rate.  The presence of a pulse informs you that the the heart is beating and that the blood vessels are effectively conducting blood into the limb with the pulse.

The absence of a:

• central pulse [carotid or femoral] implies that the heart is not effectively beating.
• peripheral pulse [radial or foot] implies that either;
  • the heart is not effectively beating,
  • the blood vessels to that limb have been compromised or
  • the blood pressure is too low for it to be felt.

A fast pulse [greater that 100 beats per minute] can occur with:

• Shock
• Pain
• Fever
• Dehydration
• Blood loss
• Certain drug, poison or venom intoxications
• And many other conditions

A slow pulse [less than 50 beats per minute] can occur with:

• Hypothermia
• Heart conditions [many of which are emergencies]
• Certain drug, poison or venom intoxications
• And many other conditions

Detecting pulses is essential in many scenarios, but most important for detecting shock early and assessing limb fractures for compromised blood supply.

 

Basic Principles

Finding pulses can be difficult, even on healthy skinny people.  To maximize you chances of locating the pulse follow the following principles

1. PRACTISE on everyone who’ll let you.  If you have a sick person in front of you it’s too late for practice.
2. Use the pads of you fingers instead of their tips, this increases the surface area you have to sense with.
3. Search for the pulse with as many finger pads on the area as possible.
4. Feel for pulses where the artery runs over a bone, this way your fingers press the artery against a hard surface that the pulse can “bounce” off.
5. If you’re confident that your finger pads are in the right spot but you can’t feel the pulse don’t move your fingers off the area right away, first try;
   • Altering the pressure you are using.
   • Rocking your finger pads slightly in the area.

 

The Essential Pulses

The Central Pulses

The Carotid Pulse

The carotid arteries run from the major blood vessels in your chest through the neck just next to the Adam’s apple [yes, women have them] and into the brain.  It is the major arterial supply for the brain and also houses important pressure receptors that help the body regulate blood pressure.

To find the carotid pulse first feel the front midline of the neck to locate the Adam’s apple.  Then place as many finger pads from one hand as you can fit next to and parallel to it.  Press gently straight into the neck.

Note:  Those pressure receptors are usually located in the bottom half of the carotid artery.  If you press hard enough on them they’ll send signals that tell the heart to lower blood pressure and the patient might faint.  For this reason look for the pulse in the upper half of the neck.

 

The Femoral Pulse

The femoral arteries runs from the major artery in the pelvis and into the legs passing superficially in your groin.  They are the major arterial supply for your legs.

To find the femoral pulse you’ll first need to locate the pubic tubercle.  This tubercle is a corner on the pelvic bone that usually sits under the pubic hair.  Press in to the pubic hair region and you’ll feel a bone, follow that bone sideways until you find the end of it.  Now place your finger pads next to it as shown in the picture below.

 

The Peripheral Pulses

The Radial Pulse

The radial artery runs from the elbow to the hand along the inside surface of the forearm.  It supplies blood to the forearm and hand.

To find the radial pulse first locate the tendons in the center on the front of the wrist.  You should be able to find 2 or 3 of them.  Next place you finger pads next to the outer most tendon on the side thumb side of the wrist as shown below.

The Dorsalis Pedis Pulse

The dorsalis pedis artery emerges from the major artery behind your shin bone at the front of the ankle joint and runs along the top of the foot next to the tendon that lifts the big toe.  It supplies the top of the foot with blood.

To find this pulse first locate the big tendon running from the big toe to the ankle.  Place your finger pads along this tendon on the little toe side.

The Posterior Tibial Pulse

This pulse is the hardest of the lot.

The posterior tibial artery emerges from the back of the knee and runs behind the calf until it take a sharp turn around the inner ankle bone from behind as it enters the bottom of your foot.  It supplies blood to the calf and bottom of the foot.

To find it first locate the inner ankle bone [proper name: medial malleolus] and place your finger pads behind it as shown.  The pulse will be found some where in the area between the bottom and rear edge of the ankle bone and the heel.

 

Finally

Remember to practice as much as you can and seek out experienced medics to help you if your having trouble with it.

 

Further reading

A guide to lower limb examination, University of California

A guide to upper limb examination, University of California