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🫀 Do You Check for a Pulse in BLS? Here’s What Every Medical Student Should Know

Updated: Jul 14

If you've just started your clinical journey or missed your Basic Life Support (BLS) workshop, you might be wondering:“Should I check for a pulse before starting CPR?”

The short answer in BLS is: No — and here’s why.


🚑 BLS: A Life-Saving Chain Without the Pulse Check

Basic Life Support (BLS) is the initial response for someone who is unresponsive and not breathing normally. It focuses on early recognition, high-quality chest compressions, and defibrillation — the core actions that save lives.

Traditionally, people were taught to feel for a pulse before starting CPR. However, this changed for a very important reason: time is brain.



❌ Why the Pulse Check Was Removed from BLS

Before the early 2000s, it was standard to check for a pulse before initiating CPR. But mounting evidence showed this step was often inaccurate and delayed life-saving intervention. In response, the American Heart Association (AHA) 2000 Guidelines and later the European Resuscitation Council (ERC) 2005 Guidelines officially removed the routine pulse check for lay responders and most BLS scenarios.

📌 Since 2000, international guidelines have discouraged pulse checks during BLS, especially for laypersons and even many healthcare professionals, unless they are trained in Advanced Life Support (ALS).

Research shows that:

  • Even healthcare professionals can struggle to reliably detect a pulse, especially in stressful or noisy environments.

  • Taking too long to check for a pulse (more than 10 seconds) delays CPR, which drastically reduces survival chances.

  • In many cases, patients who need CPR have no effective pulse, and waiting for confirmation wastes precious time.

That’s why modern BLS guidelines focus on just two checks:

  1. Unresponsiveness

  2. Abnormal or absent breathing (e.g., gasping)

If both are present, immediate chest compressions are started — no pulse check needed.



🔍 So When Do We Check for a Pulse?

While BLS skips the pulse check, there are several medical procedures where checking the pulse is still essential:


1. 🏥 Advanced Life Support (ALS)

In hospital or advanced settings, trained providers check the pulse:

  • During rhythm analysis (e.g., to confirm if a shockable rhythm is present)

  • After a shock, to assess if Return of Spontaneous Circulation (ROSC) has occurred

  • In Pulseless Electrical Activity (PEA) — where the monitor shows a rhythm, but the patient has no pulse


2. 👶 Pediatric and Neonatal Resuscitation

  • In infants and children, healthcare professionals may check the brachial, femoral, or carotid pulse.

  • If the heart rate is less than 60 bpm with poor perfusion, CPR is initiated.

  • Initial 5 rescue breaths are given before chest compressions in most pediatric algorithms.


3. 🛏️ Post-Resuscitation Monitoring

After ROSC, regular pulse checks are part of ongoing monitoring to ensure circulatory stability.



🧠 Key Takeaway

Pulse checks are not part of Basic Life Support because they can delay CPR and are often inaccurate. However, they remain crucial in advanced care settings, pediatric emergencies, and during rhythm assessments by trained professionals.

So the next time you’re on the scene:

  • If the person is unresponsive and not breathing normally, don’t waste time.

  • Start chest compressions immediately — the heart, and the brain, can’t afford to wait.


📚 References:

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