Because the radial pulse is often quickly and easily found, EMTs, paramedics and other healthcare providers will palpate — to feel — a radial pulse to count the patient’s heart rate, get a sense of the patient’s heart rate — fast or slow — and rhythm regularity — regular or irregular. Based on a radial pulse check, the healthcare provider will perform additional heart assessments, like a 3-lead or 12-lead EKG and pulse oximetry.
A radial pulse is also checked if the patient has a traumatic injury to their shoulder, upper arm, elbow, lower arm or wrist. An absent radial pulse is a sign that circulation to the tissue beyond the injury is compromised and needs to be restored through treatment. Absent or inadequate perfusion can cause tissue to become necrotic and may lead to digit or limb loss.
The radial pulse, in addition to sensation and movement, is also checked before and after the application of a splint to an upper limb injury. If circulation, indicated by a radial pulse, is present before splint application and absent after splint application, the EMS provider needs to adjust the splint’s fit to restore circulation to the tissue beyond the splint.
| Scroll to the end of the article for a radial pulse FAQ
Where is the radial pulse
The radial pulse is the blood flow with each heartbeat through the radial artery, which runs along the radius bone. The radial artery is closest to the skin surface as it passes underneath the patient’s wrist.
How to check a radial pulse
I had a college professor who, when he rested his hands behind his head, I could watch the radial arteries on his hands pulsate. For most patients, like my college professor, finding the patient’s radial pulse is fairly easy. If you are having trouble finding a conscious patient’s radial pulse, try these five tips for a radial pulse check.
1. Bare the patient’s skin
Move long-sleeved clothing, gloves, mittens, watches or jewelry out of the way. It is important to palpate (to feel) the patient’s bare skin. Attempting to feel the radial artery pulsation through one or more layers of clothing, especially in the prehospital environment, is an unnecessary extra challenge.
2. Get closer to the radial artery
Gently cock or extend the patient’s wrist to bring their radial artery closer to the surface of the skin, which will make it easier to palpate the radial pulse.
3. Touch the skin over the radial artery with two or more fingers
Palpate the distal end of the radius, this is the end of the radius that forms a bump at wrist. Then slowly draw two or three of your fingers towards the radial artery. Move your fingers proximally — toward the elbow — as you lightly feel for the the patient’s radial artery.
4. Start at the thumb and move toward the radial artery
If starting at the radius bone condyle doesn’t work, try starting at the base of the thumb. Palpate the base of the patient’s thumb. Then draw two or three fingers proximally towards the radial artery.
5. Use the pulse oximeter
If you are still having trouble, use a pulse oximeter or auscultate — to listen — the patient’s heart to get a feel for the rhythm and rate of heartbeat you are attempting to palpate. It might be easier to find the radial pulse once you have a feel for its rate and rhythm.
6. Try the other wrist
If you are unable to find the radial pulse on one wrist, switch to the patient’s other wrist.
7. Mark the location for reassessment
Once you have found a difficult-to-find radial pulse, consider using a ballpoint or felt tip pen to make a light mark at the pulse location to make reassessment easier.
What else works well for finding a radial pulse? Why might a radial pulse be absent or diminished?
Also, check out these tips to find a patient’s pedal pulse.
The radial pulse is the rhythmic throbbing of an artery as blood is propelled through it, commonly felt on the wrist. It is located on the thumb side of the forearm, just below the base of the thumb. Checking the radial pulse helps assess the heart's rhythm and strength, which are indicators of overall cardiovascular health.
To check the radial pulse, place the pads of your index and middle fingers lightly over the radial artery on the wrist, just below the thumb. Apply gentle pressure and count the beats for 30 seconds and multiply by two, or for a full minute for a more accurate reading.
Measuring the radial pulse provides vital information about a person's heart rate, rhythm, and circulation. It can help detect irregularities such as arrhythmias, tachycardia, or bradycardia. Regular monitoring of the radial pulse is important in clinical settings to assess patient stability and detect early signs of medical emergencies.
A normal radial pulse rate for healthy adults typically ranges between 60 and 100 beats per minute. Factors like fitness level, medications, and underlying medical conditions can influence the pulse rate. It's important to understand what is normal for the individual to recognize any significant changes.
As an EMT, you should check a patient's radial pulse during the initial assessment, after any interventions, and regularly during patient transport. Frequent monitoring helps identify changes in circulation and perfusion, which can be critical for diagnosing shock or deteriorating conditions.
An abnormal radial pulse can signal underlying health issues. A weak or thready pulse may indicate low blood pressure, dehydration, or shock, while a bounding pulse can suggest fever, anxiety, or high blood pressure. Recognizing these signs early is crucial for prompt medical intervention.
This article, originally published April 9, 2009, has been updated with additional information and resources.
