5.1 Infant Assessment & Brachial or Femoral Pulse Check
Key Takeaways
Check infant responsiveness by tapping the foot and shouting; do not shake the infant.
Assess breathing and a brachial or femoral pulse simultaneously for at least 5 but no more than 10 seconds.
The brachial pulse is found on the inner upper arm between the shoulder and elbow; the femoral pulse is found in the groin.
If no definite pulse is felt within 10 seconds, begin CPR rather than extending the pulse search.
A pulse below 60/min with poor perfusion despite effective oxygenation and ventilation also requires chest compressions.
5.1 Infant Assessment & Brachial or Femoral Pulse Check
An infant's small anatomy changes the responsiveness check and pulse sites, but the purpose is the same as in adult BLS: decide within 10 seconds whether circulation is adequate and begin the correct intervention.
Check responsiveness safely
After confirming scene safety, tap the sole of the infant's foot and shout. Look for purposeful movement, crying, eye opening, or another meaningful response. Do not shake the infant.
If the infant is unresponsive, call for nearby help. Activate the emergency response system and obtain an AED according to the one-rescuer or two-rescuer pediatric sequence. If a phone is available, use speaker mode so care can begin while communicating with dispatch.
Assess breathing and pulse simultaneously
Look for normal breathing while palpating either a brachial or femoral pulse. The assessment takes at least 5 but no more than 10 seconds. Gasping is not normal breathing.
Brachial pulse
- Keep the infant supine with the arm accessible.
- Locate the inner aspect of the upper arm between the shoulder and elbow.
- Place 2 or 3 fingertips over the groove between the muscles.
- Press gently until pulsation is felt.
Do not use the thumb, because the rescuer's own pulse can be mistaken for the infant's. Excessive pressure can compress the artery and make a pulse harder to detect.
Femoral pulse
The femoral pulse can be checked where the upper inner thigh meets the groin. Use 2 or 3 fingertips and gentle pressure. This is an accepted central pulse site for an infant and may be useful when the arms are inaccessible.
The infant BLS algorithm uses brachial or femoral sites. It does not direct rescuers to search the neck for a carotid pulse. The practical concern is reliable assessment in small anatomy, not a claim that touching the neck is automatically injurious.
Act on the result
| Breathing and pulse finding | Response |
|---|---|
| Normal breathing; adequate pulse | Monitor and evaluate other needs |
| Inadequate breathing; definite pulse at least 60/min | Give 1 breath every 2-3 seconds; reassess about every 2 minutes |
| Pulse below 60/min with poor perfusion despite effective oxygenation and ventilation | Begin CPR |
| No definite pulse within 10 seconds | Begin CPR |
When rescue breathing is needed, open the airway in a neutral or slightly extended position and give each breath over about 1 second with visible chest rise. An infant's large occiput can flex the neck when lying flat, so a small shoulder roll may help achieve a neutral position when appropriate.
CPR and activation details
For one rescuer, use 30 compressions to 2 breaths. With 2 or more healthcare rescuers, use 15:2. Compression rate is 100-120/min and depth is at least one-third the chest diameter, about 1.5 inches (4 cm). Use the heel of one hand or the two-thumb-encircling-hands technique; do not use the retired two-finger method.
If a lone rescuer without a phone finds an infant after an unwitnessed collapse, provide about 2 minutes of CPR before leaving to activate and obtain an AED. For a witnessed sudden collapse, activate and obtain the AED first. With two rescuers, one starts CPR while the other activates and retrieves equipment.
Common errors
- Shaking the infant to test responsiveness.
- Checking pulse and breathing sequentially rather than together.
- Searching multiple pulse sites for longer than 10 seconds.
- Using the thumb for palpation.
- Pressing so firmly that the brachial artery is occluded.
- Treating gasps as normal breathing.
- Forgetting the below-60/min bradycardia criterion when poor perfusion persists despite effective ventilation.
The exam action is determined by what can be confirmed in the brief assessment window. If a definite pulse cannot be identified, do not delay CPR for a more elaborate search.
Pulse-check rehearsal
On an infant manikin, locate the inner upper arm before starting a timer. Place 2 or 3 fingertips gently, assess breathing at the same time, and announce a decision by 10 seconds. Repeat at the femoral site. The objective is not to invent a pulse on the manikin; it is to build consistent landmarks, light fingertip pressure, simultaneous observation, and a timely decision. In a real emergency, uncertainty at the deadline is treated as no definite pulse.
Have a partner verify that your fingertips remain on the selected landmark.
Where is the brachial pulse checked in an infant?
At the wrist on the thumb side
On the inner upper arm between the shoulder and elbow
On the outer forearm
Directly over the sternum
A healthcare provider cannot feel a definite infant pulse within 10 seconds, and the infant is not breathing normally. What is next?
Search additional sites for another minute
Give abdominal thrusts
Begin CPR
Wait for the AED before acting
Which pulse sites are used for the infant BLS assessment?
Radial or carotid
Temporal or pedal
Apical only
Brachial or femoral
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