Pulse Check Duration During BLS Assessment and CPR
Healthcare providers should take no more than 10 seconds to check for a pulse during BLS assessment or CPR, and if a pulse is not definitely felt within that time period, chest compressions should be started immediately. 1
Guideline-Based Time Limits
The American Heart Association establishes a strict 10-second maximum for pulse checks across all age groups:
- Adults: Healthcare providers must check the carotid pulse for no more than 10 seconds 1
- Pediatric patients: The pulse check (brachial or femoral in infants, carotid in children) must be completed within 10 seconds 1
- During ongoing CPR: Pulse reassessment should occur approximately every 2 minutes but still limited to 10 seconds maximum 1
Critical Rationale: Minimizing Interruptions
The 10-second limit exists because delays in chest compressions directly compromise patient outcomes:
- Every second without compressions reduces coronary and cerebral perfusion 1
- If you cannot definitely feel a pulse within 10 seconds, you must assume cardiac arrest and immediately begin chest compressions 1
- The emphasis is on "definitely felt"—uncertainty should prompt immediate CPR initiation rather than prolonged pulse checking 1
Common Pitfalls and How to Avoid Them
Pitfall #1: Taking too long to assess the pulse
- Research demonstrates that healthcare providers frequently exceed the 10-second guideline, with some taking 30 seconds or more when no pulse is found 2
- Lay rescuers averaged 9.5 seconds, with only 73.7% detecting a pulse within 10 seconds in controlled conditions 3
- Solution: Use a mental countdown and err on the side of starting compressions if uncertain 1
Pitfall #2: Using ultrasound during pulse checks
- Point-of-care ultrasound during cardiac arrest nearly doubles pulse check duration to 21 seconds on average 4
- Solution: If ultrasound is used, it must be performed by experienced operators who can complete the assessment within the 10-second window, or it should be deferred 4, 5
Pitfall #3: Rechecking multiple times when uncertain
- The guidelines specify "no more than 10 seconds" as an absolute maximum, not a target 1
- Solution: If the pulse is not definitely felt within 10 seconds, start CPR immediately rather than attempting additional pulse checks 1
Simultaneous Assessment Strategy
To maximize efficiency, healthcare providers should:
- Check for breathing AND pulse simultaneously during the initial assessment 1
- Look for no breathing or only gasping while palpating the pulse 1
- This dual assessment approach prevents sequential delays that could extend the no-flow period 1
Special Considerations During Active Resuscitation
During ongoing CPR cycles:
- Pulse checks occur approximately every 2 minutes between compression cycles 1
- The 10-second maximum still applies to these reassessment pulse checks 1
- Chest compressions should resume immediately if no pulse is definitely felt 1, 6
- Post-defibrillation, most patients remain pulseless for over 2 minutes, supporting immediate resumption of compressions rather than prolonged pulse checking 6