Where should I check a pulse during a code?

Pulse Check During a Code: Carotid Artery is the Preferred Site

During a code situation, the carotid artery is the best site to check for a pulse, and healthcare providers should feel for no more than 10 seconds before deciding if a pulse is present or absent. 1

Proper Technique for Carotid Pulse Check

The carotid pulse check is a critical skill during resuscitation efforts that requires proper technique:

1. Location: Place fingers in the groove between the trachea and sternocleidomastoid muscle on the side of the neck closest to you
2. Duration: Feel for no more than 10 seconds before making a decision 1
3. Assessment: Determine if a pulse is "definitely felt" within this timeframe

Evidence-Based Concerns with Pulse Checks

Research has identified several important limitations with pulse checks:

• Healthcare providers often take too long to check for a pulse 1
• Many providers have difficulty determining if a pulse is present or absent 1, 2
• Studies show poor accuracy in pulse detection:
  • Only 15% of providers could correctly identify pulse status within 10 seconds 3
  • Only 2% correctly recognized a truly pulseless patient within 10 seconds 3
  • 45% failed to identify a pulse despite systolic pressure ≥80 mmHg 2

Current Guidelines for Pulse Checks

The 2020 AHA Guidelines emphasize:

• Healthcare providers should "look for no breathing or only gasping and check pulse (simultaneously)" 1
• A pulse should be "definitely felt within 10 seconds" 1
• If no pulse is definitely felt within this timeframe, CPR should be initiated immediately 1

Common Pitfalls to Avoid

1. Taking too long: Protracted delays in CPR can occur when checking for a pulse 1
2. Indecision: If you're not certain a pulse is present within 10 seconds, begin CPR 1
3. Incorrect technique: Proper finger placement is essential for accurate assessment
4. Excessive pressure: Using too much pressure can obliterate the pulse
5. Checking your own pulse: Avoid using your thumb which has its own pulse

Practical Algorithm for Pulse Check During Code

1. Establish unresponsiveness
2. Look for no breathing or only gasping
3. Simultaneously check carotid pulse for no more than 10 seconds
4. If pulse definitely felt:
   • If breathing normally: Monitor until emergency responders arrive
   • If not breathing normally: Provide rescue breathing (1 breath every 6 seconds)
5. If no pulse definitely felt within 10 seconds:
   • Begin high-quality CPR immediately
   • Perform cycles of 30 compressions and 2 breaths
   • Use AED as soon as available 1

Remember that minimizing interruptions in chest compressions is critical for survival outcomes. When in doubt about pulse presence, begin CPR, as the risk of harm to a patient who is not in cardiac arrest is low compared to the risk of withholding CPR from someone who needs it 1.