Which of the pulse is palpated to see the effectiveness of CPR ?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Explanation

The carotid artery is a large, central artery located close to the heart, making it a reliable indicator of circulation generated by CPR.
During cardiac arrest or shock, peripheral pulses (like radial and ulnar) weaken and become non-palpable. The carotid pulse is one of the last to be lost.
Assessing the carotid pulse reflects blood flow to the brain, which is a primary goal of resuscitation.
It is easily and quickly accessible in the neck without needing to remove significant clothing, which is critical in an emergency.

Option A: The ulnar pulse is a peripheral pulse in the wrist. It is not a reliable indicator of central circulation during the low-flow state of cardiac arrest.
Option C: The radial pulse is the most commonly checked peripheral pulse for routine vital signs, but it is unreliable for assessing CPR effectiveness because it quickly becomes non-palpable in cardiac arrest.
Option D: The temporal pulse is a superficial artery on the head. It is not a standard or reliable site for assessing circulation during a cardiac emergency in adults.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pulse assessment during CPR as background academic context rather than a clinical decision trigger.
A critical nursing and resuscitation skill is to check for a pulse for no more than 10 seconds. Any longer delay compromises brain and organ perfusion by interrupting chest compressions.
Never palpate both carotid arteries simultaneously. This can occlude blood flow to the brain and may also stimulate a vagal response, causing the heart rate to drop further.
What if the patient is an infant? For infants (less than 1 year old), the brachial pulse (on the inside of the upper arm) is the recommended site for a pulse check during CPR, as the carotid artery in their short, thick neck can be difficult to palpate accurately.

How to Approach the Question

First, identify the key concept in the question: assessing the effectiveness of CPR.
Recall the physiological state during cardiac arrest: circulation is minimal, and blood pressure is extremely low.
Differentiate between central pulses (close to the heart, like carotid and femoral) and peripheral pulses (in the limbs, like radial and ulnar).
Understand that in a low-flow state, blood is shunted to the core, making peripheral pulses weak or absent.
Evaluate the options based on this principle. Ulnar, radial, and temporal are peripheral. Carotid is central.
Conclude that the most reliable pulse to check for CPR effectiveness is a central one, making the carotid pulse the correct answer.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 18-20

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