On scene with a patient that is unresponsive and not breathing, you should

• A. Check a radial pulse
• B. Check a femoral pulse
• C. Check a brachial pulse
• D. Check a carotid pulse

Answer: (D)

When someone is unresponsive and not breathing, quickly determining whether there is a pulse guides you to start CPR or provide rescue breaths. The carotid pulse in the neck is the fastest and most reliable indicator of central circulation in an adult. It’s close to the heart, easy to locate, and gives a clear yes/no on whether a pulse is present within a brief check.

Palpating the radial or brachial pulses can be unreliable in an adult who is collapsed or in shock, and they are farther from the heart, which can delay recognizing a lack of circulation. The femoral pulse is another central site, but in an on-scene emergency the carotid site is preferred for speed and certainty.

So, you should check the carotid pulse to decide your next move: if a pulse is present but the person isn’t breathing normally, begin rescue breaths; if no pulse is detected, start chest compressions immediately.