The Delta Dispatch
Pulse Rates and How to Assess Them: Essential Skills for EMR and AFA Students
Understanding how to assess a patient's pulse is a fundamental skill for anyone pursuing EMR or AFA certification. In this blog, we cover everything you need to know about checking pulse rates, including normal ranges for adults, children, and infants, how to locate key pulse points, and how to accurately assess pulse rhythm and quality. Learn about tachycardia, bradycardia, and the significance of a weak or absent pulse, especially in trauma situations.
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:
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.
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.
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.
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.
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.
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.
SAGER: Traction Splinting A Midline Femur Fracture
At Delta Emergency Support Training, we provide in-depth advanced first aid classes that cover a variety of topics, including the proper application of a Sager splint. Our classes are designed for medical professionals and advanced first aiders who want to expand their knowledge and skills. In this guide, we'll cover how to effectively use a Sager splint to immobilize femoral shaft fractures and other leg injuries.
What is a Sager Splint?
A Sager splint, also known as a traction splint, is a medical device used to immobilize and align a fractured or injured leg. It is designed to reduce pain and swelling by applying traction to the leg, pulling the bone fragments back into alignment. The splint consists of two main components: the splint itself, which is a long, narrow rod that extends from the foot to the groin, and the traction mechanism, which is attached to the foot end of the splint.
An advanced first aider applies a Sager splint to a patient with a broken femur. The patient is lying on their back and the first aider is wearing white gloves and kneeling beside them.
The splint is typically made of aluminum or carbon fiber and is lightweight and easy to transport. It is designed to be adjustable to fit a variety of leg sizes and can be quickly and easily applied in emergency situations. The traction mechanism is usually a ratcheting system that allows the medical professional to control the amount of traction being applied to the leg. This mechanism can be adjusted to achieve the desired amount of traction and can be released easily if necessary.
The amount of pressure applied is weighed in pound with a rule of thumb being 10% of the patients body weight for a maximum of 15 pounds per femur fracture or 30 pounds for a bilateral femoral fracture.
Sager splints are used for femoral shaft fractures, which are fractures that occur in the middle of the thigh bone. These types of fractures can be serious and require immediate attention. Sager splints are effective at immobilizing the affected leg, reducing pain and swelling, and realigning the bone fragments.
What causes a femur fracture?
Femur fractures can occur due to a variety of mechanisms of injury (MOI), with high-energy trauma and direct impact being the most common causes.
High-energy trauma, which involves a significant amount of force, can be caused by car accidents, falls from a height, sports injuries, and other incidents that involve significant force. The femur can break due to the impact of the force or due to bending or twisting of the bone.
Direct impact to the thigh bone, such as a blow from a heavy object or a fall onto a hard surface, is another common MOI that can cause a femur fracture. This can occur in industrial accidents or during contact sports. In both cases, the force applied to the femur is greater than the bone's ability to absorb it, causing the bone to break.
It's important to note that the severity of the femur fracture can vary depending on the MOI and the angle of impact.
How serious is a broken femur?
A femur break, particularly a bilateral femur fracture, can be a serious and potentially limb-threatening injury. The femur is the longest and strongest bone in the human body and is responsible for supporting the weight of the body and facilitating movement. When the femur is fractured, it can cause significant pain, swelling, and deformity of the affected leg.
One of the most significant dangers of a femur break is the potential for the femoral artery to be compromised by a bone fragment. The femoral artery is a large blood vessel that runs through the thigh and supplies blood to the lower leg and foot. If a bone fragment from a femur break punctures the femoral artery, it can lead to internal bleeding, which can be life-threatening if not treated promptly.
In addition to the danger of internal bleeding, a femur break can also result in nerve damage, muscle damage, and compartment syndrome. Compartment syndrome occurs when pressure within a muscle compartment builds up, which can cause damage to the nerves, blood vessels, and muscles in the affected area. If left untreated, compartment syndrome can lead to permanent damage or loss of function in the affected limb.
Indications and contraindications
Indications:
Femoral shaft fractures:
Sager splints are commonly used to immobilize and align femoral shaft fractures, which are fractures that occur in the middle of the thigh bone. Bi-lateral or single femur fractures.
Contraindications:
Open fractures:
A compound or open fracture is a type of bone fracture where the broken bone pierces through the skin.
In a compound fracture, the exposed bone can be seen or felt through the wound in the skin, and there may be visible bleeding, swelling, and/or deformity at the site of the injury. If the skin over the fracture is broken or torn, the Sager splint should not be applied as it can cause further damage or infection.
Injuries on the effected leg:
If the patient has any other associated injuries, such as ankle or fib tib fractures, a Sager splint may be contraindicated. Additionally, if the patient has a knee injury, such as a dislocated knee, a Sager splint may not be appropriate as it can exacerbate the injury. It's important to carefully evaluate the patient with a thorough rapid body survey to rule out injuries that may effect application.
Life threatening injuries:
If a patient has a life-threatening injury, the priority is to rapidly transport the patient to a medical facility for appropriate treatment. In such cases, immobilization with a Sager splint may not be the best course of action, as it can take time to properly apply the splint, and rapid transport may be necessary to save the patient's life.
It's important to remember that in cases of multiple injuries or life-threatening injuries, the priority is to save the patient's life, life over limb. While a femur fracture can be a serious and potentially limb-threatening injury, other injuries may take precedence over the fracture.
Proper application
Assuming that the patient has been assessed and a Sager splint is deemed appropriate, the medical professional or advanced first aider will follow the steps outlined in the previous response to properly apply the splint. Proper application of a Sager splint requires medical training and should only be done by trained professionals. Here are the general steps involved in applying a Sager splint:
Assessment of the patient's injury:
Before applying a Sager splint, the medical professional should assess the patient's injury to determine if it's the right tool for the job. A physician should evaluate indications and contraindications.
Patient in a supine position:
Once it's been determined that a Sager splint is necessary, the patient should be placed in a supine position.
Remove clothing from effected area:
Any clothing that obstructs the affected leg should be trauma stripped to ensure proper placement of the Sager as well as to check for compound fractures.
Placement of the Sager:
The Sager splint should be placed on the affected leg, positioning the ankle and foot in the appropriate spot. The splint should be placed with the traction component of the device facing the foot.
Securing the splint to the leg:
The splint should be secured to the leg with straps or bandages, ensuring that it is snug but not too tight. This will help to keep the splint in place and provide the necessary support.
Application of traction:
The traction component of the Sager splint should be applied, pulling the leg gently and steadily until the desired amount of traction is achieved. This will help to reduce pain and swelling and realign the bone fragments.
Pulse, sensation, and movement check:
The medical professional should check the patient's pedal pulse, sensation, and movement in the affected leg to ensure that the splint is not causing further damage or obstruction.
Training
Sager splints are orthopedic devices that are commonly used to immobilize femoral shaft fractures. They can help to stabilize the fracture and prevent further damage to the leg or other parts of the body. However, the proper application of a Sager splint requires specialized training and should only be done by trained medical professionals or advanced first aiders.
At Delta Emergency Support Training, we provide in-depth advanced first aid classes that cover a variety of topics, including the proper application of a Sager splint.