Question

List the different sites that can be used to check a patient’s pulse.

What are the risks and benefits of checking the pulse at each site

Please type

Answer 1

The pulse is the expansion of the arteries. This expansion is caused by an increase in blood pressure pushing against the elastic walls of the arteries each time the heart beats. These expansions rise and fall in time with the heart as it pumps the blood and then rests as it refills. The pulsations are felt at certain points on the body where larger arteries run closer to the skin.

'Pulse' is one of the most well-known medical terms. It is widely familiar as a measure of the heartbeat.
The pulse is a crucial measure of the heart rate. An extremely slow pulse combined with dizziness can indicate shock and help identify internal bleeding. A pulse that is too quick, on the other hand, points to high blood pressure and cardiovascular problems. With practice, it is easy to take your own pulse and those of other people.

The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the neck (carotid artery), wrist (radial artery), at the groin (femoral artery), behind the knee (popliteal artery), near the ankle joint (posterior tibial artery), and on foot (dorsalis pedis artery). Pulse (or the count of arterial pulse per minute) is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat by auscultation, traditionally using a stethoscope and counting it for a minute. The radial pulse is commonly measured using three fingers. This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches (superficial and deep).

In a conscious adult, the radial artery is the preferred pulse point, for a number reasons:

It's less invasive. Before you put your hands on someone's neck, you need to establish trust and rapport. It's awfully disquieting and just a bit awkward to assess a carotid pulse while talking to someone. They're already under considerable stress, so reaching out and putting a hand near their throat doesn't help...it's downright alarming. Reaching for the femoral artery on the inner thigh, doubly so.
As a general rule, you should always choose the least aggressive, least invasive, least distressing option that accomplishes the task before moving onto the more aggressive choices.
If they're conscious and upright, I already know they have a carotid pulse. I don't know the rate, rhythm, or quality, but I definitely know they have one. Those unknowns can all be learned from the radial.
In nearly all cases, the conscious adult has a palpable pulse in their radial arteries that is not materially different than the carotid. In the unusual cases where the radial pulse was not palpable, it can tell you something relevant to your assessment.
A person with a radial pulse has a systolic blood pressure of at least 80. If you went right for the carotid, you wouldn't know that, only that the systolic pressure is at least 60. You would therefore learn more in the same amount of time using the radial. Better to start at the radial and switch to the carotid in the 1 or 2 out of 1000 cases where the conscious adult with no obvious arm circulation issues lacked a radial pulse.
It is easier to maintain contact with a person's wrist for an extended period than it is to keep your hand on their neck. There are a variety of circumstances where you might wish to do this. If they have an irregular heart rate, ensuring accuracy demands more time. If the pulse is bounding and you're trying to calm them down, you may opt for an extended or more frequent pulse assessment, at least for rhythm and quality if not rate.
In an unconscious/unresponsive adult, the preferred pulse point is the carotid artery. There are several reasons for this, some of which are complementary points to those of the conscious patient:

Unlike a conscious patient, the chief question we're trying to answer when checking the pulse is if they have one. Someone that's awake and talking obviously does, but that can't be assumed in an unconscious person, so it makes sense to go for the strongest point first. The absence of a pulse at any other point would not indicate the absence of a heart beat, only that it isn't strong enough to reach those more distal points.
Unlike a conscious patient, we aren't concerned with alarming them or building rapport, so there's no downside to going right to the most reliable pulse point.
An unconscious person is at greater risk of an immediately life threatening situation, so a more aggressive approach is justified.
In summary, there are pluses and minuses for each pulse and some of these are more relevant in some situations than others. With any medical procedure, the benefits and efficacy of different options must be weighed against their risks. The level of invasiveness, ease or difficulty and necessity of frequent or extended checks, the emotional effect, and the level of urgency must all be considered. There's not much to be gained from initially checking the carotid pulse of a conscious adult in most circumstances, but there are several downsides noted above. Conversely, there are no downsides to going right to the carotid on an unconscious adult.

As in other areas, there are many things in medicine that are merely a matter of preference or style. I don’t think this is one of those things. I think it's a clear enough choice, a logical decision with a right answer and a wrong answer that dictate what the standard operating procedure should be, and I would correct any trainee I was precepting who did otherwise. Absent special circumstances, conscious adults should get a radial pulse check and unconscious adults should get a carotid check.