“Why Are There Different Names For Different Pulses?”

Today I had a great question come in through our customer solutions department. Here’s what it said.
“What and why are the pulses of different ages called different things and what are they called?”

Well, I understood this to mean, what are the different locations for the different age groups in cardiac arrest or unconsciousness and so I gave the following answer.


Thank you so much for your question. It’s a great question and I think I might be able to shed some light on it.

It can be a little confusing some times as we try and decode the reason why certain things in medicine are named what they are. Basic Life Support is not immune to this same situation. In regards to the names of “pulses” and how they are named according to the age or size of the patient, I’ll try to clarify.

If I understand your question correctly, you’re talking about the three locations of the pulse check.

1. Radial, which is found in the wrist of the patient, usually used for patients who are adult or child size. Older than 1 year of age. This location is used for general pulse rate and quality but not usually for the unconscious patient.
2. Brachial, which is found in the bicep/tricep region of the upper arm on the inside of the arm. This is the location for an unconscious infant, age 1 year or younger.
3. Carotid, which is found in the neck. This would be located between the trachea and the sternocleidomastoid muscle(located on the side of the neck). One can really see this muscle well when one turns their head to one side or the other. This would be the location of choice for the adult and child(older than 1 year) unconscious patient.

There is yet another location used in emergency medicine but not usually pre-hospital and that would be the femoral artery. This is located in the groin of the patient and again is usually used for trauma patients that have C-Spine collar or the carotid is not easily accessed due to intubation etc.

The reason to use the brachial over the carotid for an infant is primarily due to the fact that most baby’s don’t have necks to speak of. They have milk catching folds of skin but other than that, their anatomy is such that an area to evaluate an accurate carotid pulse is not easily obtained. Therefore, the brachial artery is the location of choice and works extremely well for the health care professional to ascertain whether a pulse is present or absent.

In most cases for adults and children over the age of 1 year, the carotid artery is the location of choice to check for pulse presence due to it being the last place to feel a pulse prior to the blood pressure being too low to feel a pulse regardless of whether the heart is beating or not. Secondly, it’s next to the location where we are performing a head tilt and chin lift while giving rescue breaths and is convenient to the rescuer for checking pulse presence(little perk).

So, though the names of the locations can be a little challenging, they do make great scrabble words, or can make you look really intelligent at dinner parties. Remember, it’s not the feeling of a pulse that will determine if we’re going to start cardiac compressions or not, It’s the absence of signs of life that will determine that. This includes, unconscious and unresponsiveness and that the patient is not breathing normally or not breathing at all. If these two signs are present, begin CPR. Pulse checks have often given false readings and postponed cardiac compressions in a patient who needed cardiac compressions desperately.

I hope this helps anyone who may have had the same question.

Best wishes and keep on rescuing!


Roy W. Shaw, EMT-Paramedic
Director of Training and Compliance


Can Anyone Use An AED?

In this mobile vlog, Roy wanted to address the AED question asked by two different people at almost the same time. Though there may be slightly different legal rules in the U.K. Compared to the U.S., both countries follow closely related ILCOR recommendations/guidelines. Always check your local laws to be sure, but in this episode, Roy addresses what the 2010 guidelines changed and why you can probably use an AED without any formal training. Let him know what you think of his more mobile format. He’s trying a new app that would allow him to record and post from almost anywhere and anytime. Not as finished as the in-studio videos but let’s him be more efficient. He will use the other format too but will sneak in some simpler ones when time is crunched. Your comments will be appreciated. Send comments to: royonrescue@gmail.com.

The RoyOnRescue Team


When A Person’s Choking, How Do I Know When It Comes Out?

In this episode of RoyOnRescue, Roy answers a question that came in via email regarding a situation where the person did the abdominal thrusts but the object did not come out to the best of their knowledge. Should they keep doing chest compressions or is there something else that can be done to get the foreign body out of the victim’s airway. Be sure to watch this episode to get the answer.


CPR With A Knife In The Chest?

Hello Everyone!

On this episode of RoyOnRescue, Roy answers a question that came in some time ago about how to do CPR if the person has an object imbedded in their chest.  Roy sheds some light on the simple yet affective way to rescue without causing harm to yourself and to the patient.  If you’ve ever wondered what to do if a person had a knife in the chest and was in cardiac arrest, you’ll want to watch this video blog.

RoyOnRescue Team

Did I Do CPR Wrong?

In this episode of RoyOnRescue,  Roy answers an email that was just sent in regarding a person who provided CPR for a cardiac arrest victim but it was different than how the two other certified responders where doing CPR.  Please tell me we don’t give rescue breaths anymore, I hope I did the right thing, “God forbid my way was wrong”.  Roy answers this question in a way that explains how all three of the rescuers did the “Right Thing”.  Be sure to watch this episode to learn how compression only and complete CPR are beneficial for the cardiac arrest victim.

Part 2 How To Survive In The Wild…A Follow Up To Comments

There was such a great response from the last episode covering life threatening emergencies in the wild, Roy decided to record a “Part 2” response that expounds on a couple of the comments.
Are there any medications that may save a heart attack victim’s life in the wild? and, If I’m asthmatic, is there any thing I can do to increase my chances if I’m away from civilization. Be sure to watch this follow up episode to put the pieces together on how to survive in the wild.

So, don’t stop having fun and living life to the fullest, but if you’re going to go out into the wild, make sure you’ve got a game plan for surviving unexpected events.

Here’s A Test Question. You’re At The Scene Of A Car Accident…

In this episode of RoyOnRescue, Roy replies to a comment that was submitted by a student who questioned the logic as to why ProTrainings.com offers a test that would give a scenario about a car accident when it wasn’t specifically covered in the training.  Roy helps shed some light on this by applying the basic principals of basic CPR and First Aid as it relates to “Scene Size Up”, Scene Safety, and patient assessment.  He also shows how the universality of Emergency First Response can usually be applied to almost every situation.

What’s The Difference Between A TIA(Transient Ischemic Attack) and A Stroke?

In this RoyOnRescue videoblog I answer a request to expound on TIA’s or Transient Ischemic Attacks.  I found a great definition at this link.

This “mini stroke” can last from a couple of minutes to around a half hour and looks and acts like a full blown stroke.  Take a look at this RoyOnRescue post to learn the difference and what you should do if you come across someone who shows these signs and symptoms.


Best Wishes,


Roy, RoyOnRescue.com

Response To A Person Struggling With Death After CPR

An email came in from a true rescuer who got involved with a man who was in cardiac arrest over the holiday while they were enjoying themselves. They cared enough to get involved and try and save this person’s life but the man stayed dead despite their attempts. This rescuer is struggling with feelings of guilt and that she didn’t do enough. In this episode, I have a very real and honest discussion with understanding living, dying and rescue.

Response to Post About ARVD and The Contraindications of CPR?

I received a feedback post that I wanted to respond to by video:

The post read as follows:


My wife has a heart condition called ARVD. This involves the RIGHT VENTRICAL and the things you are asserting(about CPR) will injure or kill the person.  Please see the website at Johns Hopkins on ARVD. This is a congenital heart disease that WILL NOT RESPOND TO STANDARD RESCUE PROTOCOLS. Because it involves the right ventricle the symptoms and treatments are all different. Lynn wears a Medic Alert bracelet and part of the information is to NOT perform standard CPR protocols, but to contact her doctors for information on how to proceed. She has a pacemaker and ICD, and cannot be given lidocaine or any of the standard cardiac resusitation drugs that ACLS requires. We will add that oxygen, lying on the left side and transporting to a facility familiar with heart electrophysiology, and ARVD treatment. This disease is found in athletes (runners, football and basketball players,
tennis and extreme sports) who seem on the outside to be fit, but have a heart that is not functioning as it should. This disease runs in families and it traceable through genetic testing at Johns Hopkins.



It must be difficult having a loved one struggle with a cardiovascular disease as mysterious as arrhythmogenic right ventricular dysplasia(ARVD), but I want to reiterate that CPR performed by bystanders will still give more benefit than doing nothing at all.

The fact that the right ventrical is dysplastic should not have anything to do with CPR performed as an emergency intervention in order to try and circulate any increased amount of oxygenated blood to the brain and vital organs.   As with everyone who goes into sudden cardiac arrest, there is no study showing that any amount of CPR would make a cardiac arrest victims biological condition worse.  If left alone, and no automatic circulation and oxygenation is present,  the body would continue to go without gas exchange circulation.  This is why most emergency protocols, and 911 systems will encourage CPR regardless of the underlying pathology related to the cause of death.  Out in the field, the goal is to keep the victim biologically alive enough to make it to the hospital or advanced care where when applicable, reversible conditions can be made right.  I did contact John Hopkins and after a short discussion with an ER nurse, it was confirmed that ARVD has different protocols for cardiac arrest.  Most victims of ARVD do not know they have it and therefore would present as a spontaneous sudden cardiac arrest event.  If this occurs, most EMS 911 dispatch systems are going to encourage CPR. I hope this helps and I’ll let you know what I find out from the American Heart Association when they respond to my question for clarity regarding this special case. I hope this helps.

Best Wishes,

Roy, RoyOnRescue.com