I like to assess level of consciousness and both radial pulses at the same time as my initial assessments. Those two pieces of information can provide more information than most of the rest of the assessment.

it amazes me how many people ask me what I am doing, when I am marking the pedal pulses on a patient who is, or will be, immobilized. While capillary refill is a secondary way of assessing circulation, it does not provide as much information as a pulse.

I am not a fan of using the brachial pulse for infants for two reasons. Most people have a hard time finding the brachial pulse on any patient and may assess this pulse less than once a year. Yes, we should assess the brachial pulse on every patient with the blood pressure, but how many people do you know who do that? With so little experience, will their assessment be worth much?

Kids tend to stress people out, so checking for an unfamiliar pulse and checking on a child may be very stressful. Stress and tactile skill often do not go together.

And otherwise healthy infants often have strong radial pulses.

Another important assessment is pulsus paradoxus. Atrial fibrillation and premature beats are conditions that will not always produce as many radial pulses as ventricular contractions. Auscultating for an apical pulse (fancy for listen to the heart beat) will allow you to assess for this. This is also a good way to compare the pediatric pulse and can help to maintain count on some of those fast baby pulse rates.

While some books will claim that PVCsand/or PJCs and/or PACs will produce a pulse, while the others will not, there is no good rteason why a premature beat must or must not produce a pulse. Whether a pulse is produced depends on so many more things than just where a premature beat is coming from. Even if I know what kind of premature beats I am dealing with, will it change my treatment?

No. I do not believe in antiarrhythmics for more than 6 PVCs/minute.

Another point I would raise is that the time spent checking the pulse rate should be extended when the patient is hypothermic or when the rate is irregular.

Beyond that, I think this is a great explanation of the pulse check.