Do you check for pulse bilaterally or at one site at a time during a resuscitation, specifically at the carotid (carotid artery) and femoral (femoral artery) sites?

Pulse Check During Resuscitation: Single Site Assessment

During resuscitation, check for pulse at ONE site at a time (not bilaterally), specifically at the carotid artery, limiting the assessment to no more than 10 seconds before initiating chest compressions if no pulse is definitively felt. 1

Recommended Pulse Check Technique

For Healthcare Providers

• Check the carotid pulse at a single site while simultaneously looking for breathing or gasping 1, 2
• Limit the entire pulse assessment to no more than 10 seconds 1
• If no pulse is definitively palpated within 10 seconds, immediately begin chest compressions 1
• The guidelines do not recommend bilateral simultaneous pulse checks or checking multiple sites sequentially during the initial assessment 1

Why Single-Site Assessment

The evidence strongly supports checking one carotid artery at a time because:

• Time is critical - even 10 seconds is barely adequate for accurate pulse detection, and checking multiple sites would cause dangerous delays 1, 3, 4
• Research shows that only 16.5% of first responders could make any pulse decision within 10 seconds, and merely 2% correctly identified true pulselessness in that timeframe 4
• Studies demonstrate that lay rescuers needed an average of 9.46 seconds to detect a carotid pulse, with only 47.4% successful within 5 seconds 3
• Healthcare providers checking for 10 seconds were correct only 58% of the time in pulseless situations 5

Alternative Sites (Femoral)

• The femoral artery is not recommended for the initial pulse check during basic life support 1
• Femoral pulse may be used as part of the gold standard clinical judgment during advanced resuscitation to confirm return of spontaneous circulation, but this is supplementary to the carotid check 6

Critical Timing Algorithm

1. Check responsiveness (takes seconds) 2
2. Simultaneously assess breathing AND check carotid pulse at one site (maximum 10 seconds total) 1, 2
3. If uncertain about pulse presence after 10 seconds → START CPR immediately 1, 2

Common Pitfalls to Avoid

• Never check bilateral carotid pulses simultaneously or sequentially - this wastes precious time and is not supported by any resuscitation guideline 1
• Do not exceed 10 seconds for pulse assessment, as delays in starting compressions worsen outcomes 1, 7
• Do not check femoral pulse first - the carotid is the recommended site for initial assessment 1, 2
• When in doubt, start compressions - the risk of harm from unnecessary compressions is low compared to the risk of delayed CPR 1

For Lay Rescuers

• The pulse check has been de-emphasized for lay rescuers since 2000 1
• Lay rescuers should look for signs of circulation (movement, coughing, breathing) rather than attempting carotid pulse palpation 1
• If no signs of circulation are present, begin chest compressions immediately 1, 7