If you cannot feel a radial pulse, which pulse site should you palpate next and how long should you wait?

• A. Carotid pulse; up to 60 seconds
• B. Femoral pulse; up to 20 seconds
• C. Brachial pulse; up to 30 seconds
• D. Popliteal pulse; up to 90 seconds

Answer: (A)

When you can’t feel a radial pulse, check a central pulse because central circulation is a more reliable indicator of whether there is enough blood flow to the brain and vital organs. The carotid pulse is the quickest central site to assess in an unconscious or shocked patient, so it’s the best next choice. Gently palpate one carotid artery with two fingers, being careful not to press both sides at once. You can continue this palpation for up to 60 seconds to determine if a pulse is present. If a carotid pulse is felt, there is some circulation; if not after that time, proceed as pulseless and follow CPR/advanced care protocols. The other sites are less ideal in this scenario because they’re either further from the heart, more difficult to access quickly, or less reliable for confirming central blood flow in an acute setting.