FAQ Level 3 Award for First Responders on Scene: Emergency First Responder (RQF) FROS® - Online Blended Part 1

218 videos, 11 hours and 47 minutes

Course Content

The Pulse

Video 101 of 218
3 min 58 sec
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Now, let us have a look at pulse points and what pulse points tell us. First of all, what is the pulse? Well, a pulse is found where an artery goes over the top of a bone and is close to the surface of the skin. When we gently press on the skin, not too hard to cut the blood supply off but just hard enough to actually feel the artery underneath the surface of the skin. As the pulse wave of the blood being pumped from the heart goes underneath the finger, you feel a pressure change and that pressure change is what we call pulse pressure which is the pressure that the heart kicks out every time it beats. We look at blood pressure, a normal adult would run about 120 top-line systolic over 80 diastolic and the difference between the two, the 40 is the pulse pressure and that is what you feel running under your finger close to the surface of the skin over a firm surface, I.e your bone underneath your fingertip.

So we now know what the pulse is, let us have a look at actually what they tell you. The faster the pulse rate, the faster the heartbeat. The faster the heartbeat, the more stressed the patient's internal organs and body is under. The slower the heart rate, the slower the pulse rate and again affecting the internal organs. So we are actually feeling and looking for the speed, the strength and the actual force that the heart is kicking out. And it should be a nice, regular, metronomic beat with a very steady gradual pressure underneath your finger and if you feel your own pulse while watching this you will see what a normal pulse rate should be.

Some of you may have heard of a situation called White Coat Syndrome. It is a situation when you go into your GP, he will never take your blood pressure straight away and neither should you because when a patient first sees you or you first arrive on a scene, their pulse rate and their heart rate will be erratic and fast because they are frightened. You need to calm them down, reassure them, give them two or three minutes to settle and then take their pulse rate afterwards because now what we are experiencing is an accurate pulse, not something that is being driven by fright, fear, pain or anxiety.

The first time a paramedic or a doctor or nurse takes your pulse, they are not actually feeling for the rate and speed of the pulse. They are actually just feeling to see that you have a radial pulse because the radial pulse in trauma and in first response is very important because to have a radial pulse which is the first pulse that will go to on your wrist, tells them not only that you have got a heartbeat, but more importantly your blood pressure has stayed above 90. We talked about 120 over 80, well your internal organs to function properly must have a blood pressure above 90 to function correctly and to have a radial pulse you must have blood pressure above 90. So the first pulse they will take off you are only taken to check that your blood pressure is okay and compatible with your internal organs working and functioning properly. If your blood pressure is below 90, your radial pulse is the first pulse to disappear.

The last pulse to disappear will be the one in your neck, the carotid pulse. The carotid pulse is the first one we take and check for in cardiac arrest. There is no point going for a radial pulse with a patient that is deeply unconscious and who is showing signs of cyanosis, we need to check whether that patient is still alive, so there is no point going for the first pulse to go, we always go for the last pulse to go, which is the carotid pulse in the neck. The final pulse that is used in medicine, normally used in A&E departments is the actual femoral pulse. In pre-hospital work, we very rarely use a femoral pulse because it does not actually tell us a great deal, whereas the radial and carotid pulse tell us an awful lot.

Learning Outcomes:
  • IPOSi Unit three LO3.1, 3.2, 3.3 & 3.4