Fast or Slow, Strong or Weak, Regular or Irregular
I’d like to teach you how to take a pulse in three seconds or less. Yes it’s possible.
I am, quite possibly, about to contradict everything you learned about taking a patients pulse in your EMT class. Hear me out on this one.
In general, I think we overemphasize the importance of coming up with a set of numbers that represent the patients vital signs and we underemphasized the importance of placing the patients vitals in context for their condition. The pulse is a prime example of this dynamic at work.
The patients pulse holds a wealth of clinically significant information. The exact heart rate isn’t one of them. Sometimes, we get this misconception lodged in our brain that the purpose of feeling the patients pulse is to determine how many times their heart is beating each minute. We will dutifully devote 15 seconds, 30 seconds … yes some even advocate taking a full minute to make sure this number is perfectly accurate.
I disagree. You can determine everything you need to know about the patients pulse in three seconds and then move on. The next time you kneel to take a patients pulse, consider these four, clinically relevant findings instead of staring at your watch.
1. Estimate the heart rate.
That’s right, just take a guess. The more you practice this, the better you’ll get. You should be able to guess the patient’s heart rate to within four beats-per-minute in either direction. That’s as close as you need to get. Get in the habit of grabbing a pulse and estimating the rate before you look at the monitor or count it off a watch. You’ll be surprised. This isn’t as tough as it might seem.
2. Is the patient’s heart rate to fast or to slow?
Start thinking like Goldilocks. You know … from the nursery rhyme? Everything was either too much or too little or just right. Once you have an estimated idea of the pulse rate ask yourself, “Is that too fast for this patient, too slow for this patient or just right? Knowing whether the pulse is too fast or too slow in the context of this particular patient is much more important than having an exact number.
3. Is the patients pulse strong or weak?
Imagine the heart as a pump (it is) sending a wave of pressure through the arteries and out to your gloved fingers. Is it a strong pump or a weak one? Does the pulse bound strongly or is it thready and weak? This is significant.
A quick note on weak pulses; don’t spend to long searching for a pulse you can’t find. We tend to doubt ourselves when we are unable to find a pulse so we keep searching, and searching … and searching. If you can’t feel a pulse, check quickly at the brachial artery and then grab your blood pressure cuff.
If you find that the blood pressure is adequate you can always come back and search around for that pulse, but don’t delay the continued assessment of a possibly hypotensive patient to search for a pulse.
4. Is the patients pulse regular or irregular?
Does the pulse have a nice regular cadence to it or does it occur irregularly. An irregular pulse will present in gallops and pauses. It can be subtle or obvious. In some cases, an irregular pulse is not clinically important finding. In some cases it could be medical emergency. Note the regularity or irregularity of every pulse you check.
What I’d really like you to take away from this is that the exact heart rate is pretty low on the clinical significance scale. We tend to spend far too much of our time, energy and focus on obtaining a highly accurate heart rate and not enough time or focus on the things that are very significant about the patients pulse. Is it too fast or too slow? Is it strong or weak? Is it regular or irregular? There will be time later to get the heart rate nailed perfectly. And if there isn’t … it probably wasn’t that important anyway.
So what do you think? How much time do you spend taking a patients pulse on scene? Do you agree or disagree with my thoughts on the importance of that task? When is it very important to have an exact heart rate? Is it ever? Leave a comment and let me know.