When performing Cardiopulmonary Resuscitation (CPR) on adults, the typical hand position is in the center of the chest just below the nipples. Of course, that position is questioned when CPR is performed on women who has breast of different sizes. In fact, on some overweight men, placing the hands between the nipples can be deceiving as they are lower than men of normal weight. However, placing the hands in the center of the chest just a fist length above the end of the breastbone is a good placement. Moreover, the different sizes and ages forces a rescuer to place his or her hands or fingers in the center of the chest. Once we have the right position, then we can determine if our compressions are effective. Even more, with a pulse, we can determine how strong or weak the pulse is.
For any age, we need to determine the pulse at the closest region of the heart. For adults, the closet region is at the carotid artery. This is the artery that is situated on the right and left sides of the trachea. For children, the pulse is in the same location. Rescuers should be aware that when the neck has extra tissue or folds, the pulse is difficult to detect. Extra effort and patience is needed when attempting to locate the pulse with extra tissue around the neck. In some cases, the pulse can be checked in either the left or right femoral artery. These arteries are in the upper medial aspects of the thigh, very close to where the pubic hair is located.
As with any cardiac arrest, and the victim being a family member or close friend, emotions tend to relieve the rescuer of effectively using their senses to detect the pulse. Of course, the child and the infant increase the feelings because they are children, and the rescuers breathing has increased. Nonetheless, finding where to take the pulse is a crucial part of the Return of Spontaneous Circulation (ROSC).
Finding the pulse on infants requires more patience and skill. The pulse is quite simple and is easy to detect, regardless of the amount of extra tissue attached. The location for taking the pulse on the infant is situated on both arms at the brachial artery. To find the brachial artery, look at the biceps muscle. Start at the top of the muscle on the inner portion of the arm. In medical terms, this inner portion of the arm is called the medial aspect. Follow a straight line to the center of the inner muscle, slightly below the biceps and feel for the pulse.
When taking the pulse, it is important to use the index and middle finger. The other fingers are fine, but the thumb should not be used because it has its own pulse. Many times, rescuers make mistakes because he and she indicate that a pulse is felt because they are using their thumb to find it when indeed there is none. Unfortunately, for the victim, CPR is discontinued because of this mistake since the heart is truly not beating. To discontinue CPR when the heart is not beating is extremely detrimental to the survival of the victim. Therefore, taking the pulse takes skill, but with practice, mistakes can be avoided.
To practice, take the pulse of a healthy adult and child on the wrist first. Feel for the pulse and remember how fast it beats and how strong it is. This is important because when the time comes to feel the pulse on a person in cardiac arrest, one could recognize what is normal or not. In cardiac arrest, always take the pulse of an adult or child from the carotid artery.
Practice taking to pulse on a healthy infant by feeling the brachial artery. Feel how fast and strong it is to understand what is normal when you take the pulse in cardiac arrest. It is important to know that even though a pulse is present on an infant, including a small child, the pulse must be greater than forty or fifty. When the infant or child is not breathing and unconscious, it is a good idea to continue CPR until the paramedics arrive. If the rescuer is not sure if he or she feels a pulse, CPR must be started immediately.
Taking the pulse is vital for the survival of a victim in cardiac arrest. When taking a CPR class and there is a question as to where to take the pulse or place your hands for cardiac arrest, ask the instructor. The instructor is happy to clarify and demonstrate the exact location of taking a pulse in the adult, child or infant.