Correct way to take a carotid pulse

[BonnieSc]

BLS and ACLS instructors have corrected my pulse-taking, saying it MUST be done with the left hand and on the same side of the patient that I'm on. I always reach instinctively with my right hand (it's more deft and sensitive) and to the opposite side of the patient (which I find is less awkward to reach and to find the right spot). I've never gotten a satisfactory answer about why this is important. It seems like an odd bit of minutia to hang onto in these days of simplification. And it isn't specified in the ACLS manual (surely it would be, if it was important?). Any thoughts?

[madwife2002, BSN, RN]

I have honestly never thought about it before!

[wtbcrna, MSN, DNP, CRNA]

Tell these instructors to show you where it says that in the ACLS/BLS manual or the research behind only taking the carotid with the left hand. You can take a carotid pulse with either hand. Which ever way seems the most comfortable and gets the job done is the hand you should use.

[EMT-newbie]

I just pulled out my BLS manual. The only references to position are for CPR teams where the BVM is at the head and the AED and CPR people are on opposite sides of the body for access.

My guess is that your instructor is probably following a paint-by-colors teaching guide with a picture of someone using their left hand...

Though thinking about it if the pulse is stronger on one side of the neck that might explain why I walk in circles all the time

[getoverit, BSN, RN, EMT-P]

I've heard the same thing from instructors, the only rationale anyone ever provided was that checking the pulse on the opposite side may increase the risk of occluding the vessel or manipulating his larynx. I don't buy either argument.

As for the left hand, I would want to know how it could possibly make any difference which hand you used. If someone were able to palpate it with their big toe it would be fine with me.

[Vinniesguy]

I've always used my right hand and the left side of the patient - not killed anyone yet!

[Rob72, ASN, RN]

I've heard the same thing from instructors, the only rationale anyone ever provided was that checking the pulse on the opposite side may increase the risk of occluding the vessel or manipulating his larynx. I don't buy either argument.

As for the left hand, I would want to know how it could possibly make any difference which hand you used. If someone were able to palpate it with their big toe it would be fine with me.

This is the reason, in conjunction with sympathetic grip-response- if you pull with your fingers, under stress, you will form an opposing clasp with your thumb. Most people are right hand dominant, so sympathetic response is stronger on the dominant side. The instructors are trying to keep you from killing someone by putting functional checks in the way of your stream of consciousness.

I can go into a very long exposition in relation to professional shooting, tactical medicine and extreme sports learning/performance studies, but the above is pretty much "it". There are a few (veryveryvery few-as in low single digits) performers who do not have substantial adrenal responses under pressure. These are people who will actually be thinking through their responses at speed.

99% of the rest perform to their lowest level of training, and their mind fills in what they expected/should have done, in post-incident debriefing. This is demonstrated by video capture as related to statements made by participants.

Edit: Anecdotally, absolutely, many of us can say, "I've done it this way and never..." Maybe. As with needle safety, if you do the right thing, the right way, each and every time, consciously, that may be a valid statement. If we do what we feel we should do/is easy, we introduce too many variables to make a defensible statement.

[psu_213, BSN, RN]

I agree that we should not say "I've always done it this way, never got into trouble with it, so I will keep doing it this way" in the place of doing it the best way as proven by evidence. I definitely see the rationale for taking the pulse on "your" side, not the opposite side. I cannot, however, buy the idea that it must be done with the left hand. I understand the point about the sympathetic response being stronger on the dominant side, but what if the student/provider is left handed? It seems wierd to base everything we do on evidence/statistics and then say "eh, we'll do it this was because there are more righties that lefties."

I have never been told by an ACLS/BLS instructor which hand to use to take a pulse. It seems to me that in the situation descibed they are not telling you to use the left hand because they know of evidence behind the practice...

[Rob72, ASN, RN]

I have never been told by an ACLS/BLS instructor which hand to use to take a pulse. It seems to me that in the situation descibed they are not telling you to use the left hand because they know of evidence behind the practice...

As with most "Standards", it tries to cover the majority, most of the time. Most right handed practioners will position themselves on the pt's left side, if given a choice. In this position, the right hand can be locating the xiphoid, while the left gets a pulse/absence thereof. Part of it is rationale, part of it is statistics.

[Biffbradford]

As mentioned ^^^, I think they want your right hand to be ready to get back to compressions ASAP. Every second counts.

[tryingtohaveitall]

As with most "Standards", it tries to cover the majority, most of the time. Most right handed practioners will position themselves on the pt's left side, if given a choice. In this position, the right hand can be locating the xiphoid, while the left gets a pulse/absence thereof. Part of it is rationale, part of it is statistics.

If you're on the patient's left, wouldn't you use your left hand to position for compressions and the right to check for a carotid pulse? Doing it as written above, wouldn't your arms be crossed?

[Rob72, ASN, RN]

Good catch- I did mean on the pts right.