Clinical Skill Information Sheet
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Pulse Assessment
Aim
To safely and effectively measure a patient’s pulse at various anatomical locations
Indications
Pulse assessment is part of a thorough patient assessment and occurs in the primary
survey. It is also used for reassessment as part of a secondary survey or overall
clinical assessment of a patient.
Background
Pulse checks are an integral part of the patient assessment. They often occur in either
the primary and/or secondary assessment of a patient. It is essential that they are
evaluated early in the patient assessment and then regularly reassessed. As part of
the pulse assessment, not only are we confirming if a pulse is present or absent, we
are also assessing for regularity, strength, rate and sometimes the correlation with a
heart monitor/rhythm.
There are many sites within the human body that a pulse can be accurately
measured. Most often a paramedic will use the carotid, brachial, radial, femoral and
pedal sites for pulse assessments. This is because these are sites that can easily be
located. The pulse should be strongest the more central it is on the patient’s body, e.g.
a carotid pulse will be stronger than a pedal pulse. If you cannot feel a peripheral
pulse, work your way more central. If you gain a carotid pulse post cardiac arrest,
ensure you palpate pulses more peripherally so you can gauge the cardiac output
more accurately.
Bachelor of Paramedic Science
Clinical Skill Information Sheet
Objective
Manage
Safety
Rationale
Safety is the first
priority in managing
any patient.
Action
1. Use universal precautions. Always wear
gloves and goggles when attending to a
patient.
2. You may also want to consider wearing a
facemask and gown.
1. Ensure you have a clock or watch in clear
view. It must have a seconds counter.
Prepare the
equipment
Prepare the
patient
Find the
anatomical
landmark
Having all of your
equipment ready to go
before assessing the
patient saves time and
ensures a professional
execution of clinical
observations.
Before undertaking
1. Introduce yourself to the patient
any patient
2. Ask the patient for permission to assess their
assessment it is vital
pulse. This may involve holding their wrist,
that you have
arm, leg or foot.
permission to touch
the patient and
3. Ensure that you explain the procedure to the
perform the intended
patient as you undertake it to provide them
assessment.
with reassurance.
Usually the
measurement of a
carotid pulse is only
performed on
unconscious patients
and therefore it is not
necessary / practical to
seek permission in this
instance.
Finding the specific
1. Using the pads of at least two fingers (not
anatomical landmarks
thumb), locate the appropriate landmark:
will help to ensure you
Radial Pulse
are accurately
measuring the arterial a) To measure the radial pulse expose the
patient’s wrist.
pulse at each of the
locations.
b) Place their hand in a comfortable position,
palm facing upwards. You may like to rest
The thumb is another
their hand on a table or their knee if they are
location in the human
sitting.
body where a pulse
can easily be palpated.
c) Place the pads of your chosen fingers on the
For this reason, you
anterior aspect of their wrist, 2cm below the
must only use your
base of their thumb, directly in line with their
fingers to measure
radius bone.This will be the lateral aspect of
pulses.
their lower arm, directly over the radial artery.
Picture shown over page.
Bachelor of Paramedic Science
Clinical Skill Information Sheet
Objective
Rationale
Action
When using pulses for
neurovascular
assessment, as often
occurs with the pedal
pulse, ensure that you
mark it with a pen after
locating it. This will
help with your
reassessment, as you
will easily be able to
determine if the pulse
strength, rate or
presence has
diminished or
Brachial Pulse
vanished.
a) To measure the brachial pulse, expose the
patient’s anterior elbow.
Make sure that you do
b) Place their arm in a comfortable position, it is
not apply too much
often easiest if their palm is facing upwards.
pressure as to harm
the patient. Too much
c) Place the pads of your chosen fingers on the
pressure will also
medial aspect of the patient’s inner elbow.
crush the artery
This will be directly over the brachial artery at
making it more difficult
the distal part of the humorous.
to feel a pulse
Carotid Pulse
a) To measure the carotid pulse, expose the
patient’s anterior and lateral neck. You may
need to perform a manual airway maneouvre
if the patient is unconscious and ensure you
consider c-spine immobilisation with this
step.
b) Place the pads of your chosen fingers on the
anterior triangle of the neck, lateral to the
larynx and anterior to the
sternocleidomastoid, just under the angle of
the jaw. This is directly over the carotid
artery. Picture shown over page.
Bachelor of Paramedic Science
Clinical Skill Information Sheet
Objective
Rationale
Action
Femoral Pulse
a) To measure the femoral pulse, expose the
patient’s lateral pelvis.
b) The patient needs to be positioned supine for
this measurement.
c) Place the pads of your chosen fingers
midway between the anterior portion of the
iliac crest and the pubic tubercle.
Pedal Pulse
a) To measure the pedal pulse, expose the
patient’s foot.
b) Place the pads of your chosen fingers in the
middle of the dorsum of the foot. Picture
shown over page.
Bachelor of Paramedic Science
Clinical Skill Information Sheet
Objective
Feel pulse
Measure for
presence
Measure for
strength
Measure for
regularity
Rationale
Depending on the
location that you have
selected to measure
the pulse, you may
need to apply varying
degrees of downward
pressure in order to
ascertain a pulse.
Action
1. After locating the pulse site, press down on
the patient’s skin.
2. Increase the downward pressure until you
can feel a pulsating beat.
Depending on the
1. Ensure you are palpating the correct location.
patient’s neurovascular
status, they may or
2. Continue palpating for at least 5 seconds to
may not have a
determine if the patient has a pulse.
detectable pulse at a
certain site, so do not
3. If you cannot palpate a pulse at a peripheral
guess or pretend that
site, move more central and evaluate the
you can feel it if you
pulse at that location.
can’t.
A strong pulse reflects
good perfusion status.
If a pulse is easy to
feel and can be
described as
bounding, then it is
considered a strong
pulse.
1. Palpate the pulse for at least 10 seconds and
determine if it is ‘bounding’ or difficult to
detect. The pulse can be described as either
strong or weak.
A pulse should be, but
is not always,
synchronous with the
patient’s heart rhythm.
A sinus rhythm should
be regular and the
pulse should reflect
this. Certain heart
rhythms may cause
irregular pulses; this is
common in patients
with atrial fibrillation.
1. Whilst palpating the pulse, measure that
each beat is occurring at a regular time
interval. You can do this by using your watch
to ensure that beats are evenly spaced. A
pulse can be described as either regular or
irregular.
Bachelor of Paramedic Science
Clinical Skill Information Sheet
Objective
Measure for
rate
Rationale
The patient’s pulse
rate should match
what is physiologically
expected. Each
individual will have
varying ‘normal,
resting’ pulse rates.
Sometimes patients
will be able to tell you
what their normal
pulse rate is. Other
things that influence
pulse rate include
increases in metabolic
demands, e.g.
exercise, infection etc.
Another consideration
is age. See the table to
the right for expected
pulse rates for
particular age groups.
Action
1. Whilst palpating the pulse ensure you can
easily view your watch / clock’s second
counter.
2. Count the amount of beats that you feel in a
30 second period.
3. Multiply the number of beats by 2. This will
give you the patient’s pulse rate per minute.
Alternatively you can count the number of
beats in a 15 second period and multiply by 4
giving you the patient’s pulse rate per minute.
Age group
Beats/minute
0-3months
120 to 160
3months-2years
120 to 140
2-5 years
100 to 120
5+ years
60 to 100
Bachelor of Paramedic Science