What are the major pulse points that an Emergency Medical Technician (EMT) checks when evaluating a patient?

Major Pulse Points for EMT Patient Evaluation

EMTs should primarily check the carotid artery for pulse assessment during cardiopulmonary resuscitation and emergency evaluation, as it is the most reliable central pulse point in critical situations. 1, 2

Primary Pulse Points in Emergency Assessment

Carotid Artery (Central Pulse - Primary Site)

• The carotid pulse is the gold standard for pulse checks during cardiopulmonary resuscitation, with significantly higher sensitivity compared to other sites when detecting the presence of circulation 2
• Located in the neck, lateral to the trachea, the carotid artery should be palpated for up to 10 seconds to achieve greater than 95% detection accuracy 1
• The carotid pulse remains palpable when peripheral pulses may be absent due to shock or low perfusion states 2
• Important caveat: Healthcare providers demonstrate only 55% specificity in carotid pulse assessment, meaning false positives occur frequently, and proper training is essential 3

Radial Artery (Peripheral Pulse - Secondary Site)

• The radial pulse at the wrist is the most rapid and reliable peripheral pulse to identify in stable patients, with 98% identification rate within 5 seconds 4
• This site is preferred for routine vital sign monitoring and assessment of peripheral perfusion 1, 5
• Loss of radial pulse while carotid pulse remains present indicates significant hemodynamic compromise 4

Femoral Artery (Alternative Central Pulse)

• The femoral pulse in the groin can serve as an alternative central pulse point, though it demonstrates lower sensitivity than the carotid artery for detecting circulation during CPR 2
• This site may be useful when carotid access is difficult due to cervical spine precautions or anatomical barriers 2
• Femoral pulse assessment is included in post-procedural monitoring protocols, particularly after arterial catheterization procedures 1

Brachial Artery (Pediatric and Alternative Site)

• The brachial pulse in the antecubital fossa or medial upper arm serves as an important assessment point 4
• This site is particularly relevant for blood pressure measurement and when radial access is compromised 5

Clinical Application Algorithm

For cardiac arrest or unresponsive patients:

1. Check carotid pulse for up to 10 seconds while simultaneously assessing for breathing 1
2. If no definitive pulse is felt within 10 seconds, begin CPR immediately rather than continuing to search for a pulse 1, 3

For conscious patients with suspected acute coronary syndrome or stroke:

1. Assess radial pulse for rate and rhythm as part of vital signs monitoring 1
2. Check bilateral radial pulses to identify asymmetry suggesting vascular compromise 1
3. Monitor pulse every 5 minutes during active procedures or critical interventions 1

For post-procedural monitoring (after arterial access):

1. Assess distal pulses (radial for upper extremity, dorsalis pedis/posterior tibial for lower extremity) to ensure adequate circulation 1
2. Check arteriotomy site and distal pulses every 15 minutes for the first hour, then every 30 minutes for the next hour 1

Critical Pitfalls to Avoid

• Do not spend more than 10 seconds attempting to locate a pulse in suspected cardiac arrest - this delays critical chest compressions and worsens outcomes 1
• Recognize that even trained healthcare providers incorrectly identify pulse presence or absence in up to 45% of cases, so when in doubt during cardiac arrest, begin CPR 3
• Avoid relying solely on peripheral pulses (radial, pedal) in shock states, as these may be absent despite adequate central circulation 4, 2
• Do not assume pulse check accuracy improves with speed - studies show only 2% of rescuers correctly identify pulselessness within 10 seconds 3
• For lay rescuers, pulse checks are not recommended - instead, they should look for signs of life (breathing, movement) and begin CPR if the patient is unresponsive and not breathing normally 1

Integration with Other Vital Signs

• Pulse assessment should occur simultaneously with evaluation of blood pressure, respiratory rate, oxygen saturation, and level of consciousness 1, 5
• In stroke patients, pulse assessment is part of the rapid neurological evaluation but should not delay transport to a stroke center 1
• During acute coronary syndrome evaluation, pulse rate and rhythm help risk-stratify patients, with heart rate >100 bpm indicating higher risk 1