Which of the following is the correct way to check for a carotid pulse in a patient who is hypothermic and unconscious?

• A. Check radial pulse for up to 45 seconds.
• B. Check carotid pulse for 15 seconds.
• C. Check femoral pulse for up to 60 seconds.
• D. Check carotid pulse for up to 45 seconds.

Answer: (D)

In a hypothermic, unconscious patient, focus on a central pulse because peripheral pulses can be unreliable when the body is cold and vasoconstricted. The carotid pulse is the best indicator of whether circulation is present. Hypothermia slows the heart, so you may need more time to detect a pulse; assess the carotid for up to 45 seconds before deciding there is no pulse and starting CPR. A shorter check could miss a very slow pulse, while waiting a full minute unnecessarily delays treatment.