Pulse Rates and How to Assess Them: Essential Skills for EMR and AFA Students

Understanding Pulse and Heart Rate: Key Concepts for EMRs and AFA Students

In emergency medical response (EMR) or advanced first aid (AFA), one of the essential skills you will learn is how to assess a patient's pulse or heart rate. A person's pulse provides valuable information about their circulatory status, and understanding how to measure it accurately is crucial for diagnosing and managing a variety of medical conditions.

This blog will guide you through the basics of pulse and heart rate, including normal rates for children, adults, and infants. We’ll also dive into how to accurately check a pulse, how to interpret its rhythm and quality, and the significance of an absent or weak pulse, especially in cases of trauma.

What is Pulse?

The pulse is the rhythmic expansion and contraction of an artery as blood is pumped through it by the heart. This beat is felt in various areas of the body known as pulse points. The pulse gives critical information about heart rate, rhythm, and strength.

Normal Pulse Rates by Age

It’s important to know the typical pulse rates for different age groups. The rate can vary based on the individual’s age, activity level, and overall health. Here’s a breakdown of normal resting pulse rates:

• Infants (0-1 year): 100-160 beats per minute (bpm)

• Children (1-10 years): 70-120 bpm

• Adults (11+ years): 60-100 bpm

• Well-conditioned Athletes: 40-60 bpm (can be normal for some athletes due to a lower resting heart rate)

As you become more familiar with pulse assessment during your EMR or AFA training, you’ll quickly learn how to identify what’s normal for your patient population.

Main Pulse Points and How to Check a Pulse Accurately

As an EMR or AFA student, knowing where to check for a pulse is a fundamental skill. You’ll need to be able to check for a pulse at several key points on the body. Here are the primary pulse points, along with instructions on how to check them accurately:

1. Radial Pulse (Wrist)

   • Location: On the thumb side of the wrist.

   • How to Check: Place your index and middle fingers on the patient’s wrist, just below the base of the thumb. Apply gentle pressure until you feel the pulse.

   • Position: The patient should be seated or lying down in a relaxed position. It is important not to use your thumb, as it has its own pulse that could interfere with the assessment.

2. Carotid Pulse (Neck)

   • Location: In the groove of the neck, just to the side of the windpipe.

   • How to Check: Place your index and middle fingers on the side of the patient’s neck, between the trachea and the muscle. Do not press too hard, as it can cause discomfort or interfere with blood flow.

   • Position: The patient can be seated or lying down. If the patient is unresponsive, the carotid pulse is typically the first point to check in an emergency.

3. Brachial Pulse (Upper Arm)

   • Location: On the inner side of the upper arm, near the elbow.

   • How to Check: Place your index and middle fingers on the inside of the patient’s arm, midway between the shoulder and elbow. Apply gentle pressure to feel the pulse.

   • Position: This pulse is often used to assess infants, as it’s the most reliable pulse point in children under one year old.

4. Femoral Pulse (Groin)

   • Location: In the crease of the groin, just below the inguinal ligament.

   • How to Check: Place your fingers on the upper thigh, near the groin. Apply firm but gentle pressure to detect the pulse.

   • Position: The patient should be lying down, preferably in a supine position. This pulse is often used in cases of severe trauma or shock.

5. Posterior Tibial Pulse (Ankle)

   • Location: Behind the medial malleolus (the bony prominence on the inner side of the ankle).

   • How to Check: Place your fingers behind the ankle bone and press gently to feel the pulse.

   • Position: The patient should be lying or sitting with the foot relaxed.

6. Dorsalis Pedis Pulse (Foot)

   • Location: On the top of the foot, between the first and second metatarsals.

   • How to Check: Place your fingers on the top of the foot, slightly to the medial side, and gently press to feel the pulse.

   • Position: The patient should be in a seated or supine position, with the foot relaxed.

How to Assess Pulse Rhythm and Quality

When assessing a pulse, it’s essential to evaluate not only the rate but also the rhythm and quality:

• Rhythm: The rhythm of the pulse refers to the regularity of the heartbeat. It can be classified as:

  • Regular: The pulse follows a consistent, steady pattern.

  • Irregular: The pulse has an erratic or uneven rhythm, which could indicate an arrhythmia or other heart conditions.

• Quality: The quality of the pulse refers to its strength. A pulse can be:

  • Strong and Bounding: A pulse that is easy to feel and forceful, which could indicate conditions such as fever, anxiety, or hyperthyroidism.

  • Weak or Thready: A pulse that is faint and difficult to feel, often indicating shock, blood loss, or dehydration.

  • Absent: If no pulse is felt at a pulse point, it may suggest severe trauma, a blocked artery, or cardiac arrest.

Tachycardia and Bradycardia

When evaluating pulse, you may encounter conditions such as tachycardia (a rapid heart rate) or bradycardia (a slow heart rate):

• Tachycardia: A heart rate that exceeds 100 bpm in adults. Tachycardia can be caused by fever, stress, anemia, or cardiovascular problems.

• Bradycardia: A heart rate below 60 bpm in adults. Bradycardia can indicate heart conduction issues, but it is also common in well-conditioned athletes.

Weak or Absent Pulse in Trauma

In trauma cases, an absent or weak pulse can be a critical sign. Trauma, especially internal bleeding or blocked arteries, can lead to a diminished pulse. If there is significant internal hemorrhaging, the pulse may become weaker in the lower extremities or other areas far from the heart. In cases of severe blood loss, the body shunts blood away from the extremities to maintain circulation to vital organs, resulting in weak or absent pulses in the arms or legs.

A blocked artery due to a clot, injury, or constriction can also result in an absent pulse distal to the blockage. Immediate intervention is needed in these cases to restore blood flow and stabilize the patient.

Conclusion

As an EMR or AFA student, learning to assess a patient’s pulse accurately is essential to providing effective care in emergency situations. Understanding the normal pulse rates, knowing how to check a pulse at key locations, and being able to interpret pulse rhythm and quality will greatly improve your ability to assess a patient’s condition. Additionally, recognizing the significance of weak, absent, or irregular pulses can help you identify life-threatening conditions like trauma, internal bleeding, or blocked arteries.

At Delta Emergency, we teach our students how to properly assess and respond to real-life emergencies. With expert instructors who are experienced paramedics, our courses ensure that you're prepared to make quick and informed decisions during critical situations.

Basic Life Support Training Series: Part 2

Welcome back to the second part of our blog series on Basic Life Support (BLS). In the first blog, we discussed scene assessment, the ABC check (Airway, Breathing, and Circulation), and the proper use of CPR and AED. Now, in part two, we will delve into life-saving interventions and devices used within each step of the ABC check. Let's explore the crucial steps that can make a significant difference in saving lives.

Head tilt chin lift in basic life support training class

Life Saving Interventions: Airway

Airway management is a critical component of Basic Life Support (BLS) and plays a crucial role in ensuring the patient's ability to breathe effectively. In addition to the manual maneuvers we discussed earlier, such as the head tilt-chin lift and jaw thrust, there are other devices that can be used to secure and protect the airway. Let's explore two commonly used devices: the Oropharyngeal Airway (OPA) and the Nasopharyngeal Airway (NPA).

1. Oropharyngeal Airway (OPA):

The oropharyngeal airway, is a curved plastic tube that is inserted into the patient's mouth to maintain the patency of the airway. It serves two main purposes:

a) Clearing Obstructions: The OPA helps to displace the tongue from the back of the throat, preventing it from obstructing the airway and impeding the passage of air. This is used for unconscious patients or those with decreased consciousness.

b) Facilitating Manual Stabilization: By providing a firm structure, the OPA allows rescuers to perform manual stabilization of the patient's head and neck, as it helps maintain the alignment of the airway.

When using an OPA, it is important to select the correct size for the patient to ensure proper placement and prevent complications. Insert the device upside down, rotating it 180 degrees as it reaches the back of the throat. Proper placement should allow the device to sit between the teeth or lips and the base of the tongue.

1. Nasopharyngeal Airway (NPA):

The nasopharyngeal airway, or nasal airway, is a flexible tube inserted through the nostril into the back of the throat. It is particularly useful in patients who have an intact gag reflex or clenched teeth, making oral insertion difficult or risky. The NPA has several advantages:

1) Improved Comfort: The NPA is generally better tolerated by conscious or semi-conscious patients as it avoids stimulation of the gag reflex.

2) Unobstructed Oral Access: By securing the airway through the nasal passage, the mouth remains free and accessible for other procedures, such as suctioning or oral medication administration.

To insert an NPA, select the appropriate size by measuring from the tip of the nostril to the earlobe or the angle of the jaw. Lubricate the device before gently inserting it along the floor of the nasal passage, aiming towards the back of the throat. Monitor for signs of discomfort or obstruction during insertion and adjust if necessary.

It is important to note that the use of OPAs and NPAs requires proper training and an understanding of the patient's anatomy and potential contraindications. Rescuers should be cautious and attentive to the patient's response while using these devices.

By employing manual maneuvers like the head tilt-chin lift and jaw thrust, along with the use of OPAs and NPAs, rescuers can effectively secure and maintain an open airway for patients in need of Basic Life Support. Remember, accurate assessment and regular practice are essential to ensure proper airway management in emergency situations.

Life Saving Interventions: Breathing

Various devices can be used to provide oxygenation and ventilation support. Let's explore the different devices commonly used in BLS:

1. Nasal Cannula:

The nasal cannula is a lightweight device that delivers supplemental oxygen through two small prongs inserted into the patient's nostrils. It provides a low to moderate flow rate of 1-4 liters per minute (LPM) with an oxygen concentration ranging from 25% to 45%. The nasal cannula is comfortable and allows patients to speak, and move freely while receiving oxygen.

Simple Face Mask:

The simple face mask is a mask that covers the patient's nose and mouth, delivering oxygen at a flow rate of 6-10 LPM. It provides a higher oxygen concentration compared to the nasal cannula, ranging from 40% to 60%. The simple face mask is commonly used in patients who require higher oxygen levels or when a more precise oxygen concentration is not required. However, it may impede communication and patient comfort.

Non-Rebreather:

The non-rebreather is a mask with a reservoir bag attached, ensuring the delivery of high concentrations of oxygen. It has one-way valves that prevent the patient from inhaling exhaled air and allow for a flow rate of 10-15 LPM. The non-rebreather mask can deliver an oxygen concentration of 90% or higher. It is particularly useful in patients with severe hypoxia or in cases where precise oxygen titration is necessary.

Bag-Valve-Mask (BVM):

The bag-valve-mask (BVM) device, is a manually operated resuscitator used to provide positive pressure ventilation. It consists of a self-inflating bag, a one-way valve, and a mask. The BVM is connected to an oxygen tank with a flow rate of 15 LPM, providing an oxygen concentration close to 100%. The BVM is often used in cases of respiratory distress or respiratory arrest, when the patient is not breathing adequately or requires assisted ventilation.

During assisted ventilation with a BVM, 1/3 of the bag should be compressed once every 5-6 seconds to achieve a target ventilation rate of 10-12 breaths per minute.

Newer BVM’s include a safety valve that makes a noise if you are compressing the bag too hard or fast, allowing for user friendly use.

As you provide assisted ventilation using a BVM, pay close attention to the patient's response. Look for chest rise and fall with each breath delivered. The presence of chest rise indicates that the ventilation is effectively reaching the patient's lungs.

Additionally, observe the patient's overall color. Effective ventilation should help improve the patient's skin color, with a return to a more normal or healthier appearance. If the patient's color improves, it is a positive sign that oxygenation and ventilation are being adequately supported.

It is important to note that when administering oxygen, the flow rate should be carefully adjusted based on the patient's condition and oxygen saturation levels. Oxygen therapy should be monitored closely.

Circulation assessment

Circulation assessment is a crucial step in Basic Life Support (BLS) to determine the adequacy of blood flow. While CPR remains the life-saving intervention when a pulse is not detected, let's explore other methods to assess circulation when a pulse is present.

1. Capillary Refill: To assess capillary refill, gently press down on the patient's nail bed or the tip of their finger. Upon releasing the pressure, observe how quickly the color returns to the area. A normal capillary refill time is around 2 seconds. If color returns within this timeframe, it indicates good capillary refill and suggests adequate peripheral circulation.

2. Extremity Warmth: Feeling the temperature of the patient's extremities, such as their hands and feet, can provide valuable information about circulation. Warm extremities indicate good blood flow, while cold extremities may suggest impaired circulation.

It's important to note that these assessments are complementary to the presence of a pulse. If there are concerns about circulation or any signs of poor perfusion, prompt medical attention should be sought.

1. Circulatory Obstruction: Major blood loss from an injury can obstruct circulation and pose a life-threatening situation. In such cases, immediate action is crucial. If the hemorrhage is external, apply direct pressure to the bleeding site using PPE always. Maintaining pressure helps control the bleeding and promotes clot formation, thereby restoring circulation. If available, consider the use of a tourniquet for severe hemorrhage that cannot be controlled by direct pressure alone.

Remember, it is important to prioritize personal safety and seek professional medical help as soon as possible in cases of significant bleeding or other circulatory emergencies. Timely intervention can make a significant difference in patient outcomes.

Training

Mastering Basic Life Support (BLS) is crucial for healthcare professionals, including nurses, doctors, dentists, firefighters, and other first responders. Understanding the key steps for assessing and applying critical interventions for airway, breathing, and circulation is essential to deliver timely and effective care during emergencies. At Delta, we recognize the importance of BLS training, as it is often required to be completed yearly for professionals in various fields. We are dedicated to providing frequent BLS courses to equip individuals with the life-saving skills they need. Enroll in our BLS courses today and stay prepared to make a difference when it matters most.