# Pulse check before ABCs in an Unresponsive PT?



## benasack2000 (Jun 25, 2015)

Hey everyone. For any unresponsive patient (medical or trauma), would you check for the presence of a pulse before moving on to the ABCs? I think I recall my instructor saying that but my textbook says otherwise. I'm not sure. Is CAB the steps of assessment for an unresponsive pt. OR just the steps of CPR? Can someone explain?


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## Jim37F (Jun 25, 2015)

No signs of life, check pulse first. 

No pulse after 10 seconds start CPR (CAB-Compressions-Airway-Breathing)

Signs of life present/palpable pulse, continue normal assessment using ABC (Airway-Breathing-Circulation)


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## benasack2000 (Jun 25, 2015)

And you would also ascertain the presence of breathing or agonal gasps while you were checking the pulse?


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## cprted (Jun 25, 2015)

You pretty much do your ABC simultaneously for a non responsive patient.  Head tilt/chin lift while looking and listening for breathing and palpating for a carotid pulse.  C-A-B is the order of interventions is you find your patient to be pulseless.


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## Jim37F (Jun 25, 2015)

Well since you're checking to carotid pulse on the neck, unless you have a severe case of tunnel vision there's no reason you can't look, listen, feel for breathing while palpating for the pulse


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## Gurby (Jun 25, 2015)

On the subject of breathing, this video was pretty eye opening for me.  Just because they're breathing doesn't mean they aren't in cardiac arrest...


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## Underoath87 (Jun 25, 2015)

It has been CAB for years now.  Let the C stand for "circulation" and that covers your initial pulse check, with compressions immediately following if you don't find a carotid pulse within 10 seconds.


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## Brandon O (Jun 25, 2015)

The AHA CPR curriculum describes it as "not responsive" -> "not breathing normally" -> "check for a pulse up to 10 seconds" -> start CPR. This essentially follows the ABCs anyway.

Realistically you'd look for breathing while checking the pulse.


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## RedAirplane (Jun 25, 2015)

This is one place where I like the Red Cross CPR/AED for Professional Rescuers better than the AHA BLS even though both are based on AHA guidelines.

In the Red Cross version, I was taught that ABC are the things to check, but the order is de-emphasized. In particular, open the Airway, then you *can* and *should* check for breathing and a pulse at the same time.


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## Brandon O (Jun 25, 2015)

Similar with the AHA material. They haven't worried too much about order since 2010; it's recognized that things will typically happen concurrently.


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## RedAirplane (Jun 26, 2015)

Brandon O said:


> Similar with the AHA material. They haven't worried too much about order since 2010; it's recognized that things will typically happen concurrently.



The AHA video is (in my opinion) confusing compared to the Red Cross one, especially with the bunch of stuff about when to use which acronym. But maybe they're all saying the same thing and one is just tougher for me to make sense of.


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## Noncreative (Jul 2, 2015)

Basically the difference between a responsive PT and unresponsive is that you quickly check pulse and breaths for 10 sec before ABC ect. At least, that's what AHA says.


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## benasack2000 (Jul 4, 2015)

The AHA guidelines for CPR don't include opening the airway before checking for breathing and a carotid pulse. In real life, would I would open the airway BEFORE I check breathing? Why doesn't the AHA include opening the airway first?


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## Underoath87 (Jul 4, 2015)

benasack2000 said:


> The AHA guidelines for CPR don't include opening the airway before checking for breathing and a carotid pulse. In real life, would I would open the airway BEFORE I check breathing? Why doesn't the AHA include opening the airway first?



IRL, if someone isn't obviously breathing, perform a trap squeeze while checking a carotid pulse.  If you don't feel one, start compressions and let your partner worry about opening the airway and ventilation.


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## Flying (Jul 4, 2015)

benasack2000 said:


> The AHA guidelines for CPR don't include opening the airway before checking for breathing and a carotid pulse. In real life, would I would open the airway BEFORE I check breathing? Why doesn't the AHA include opening the airway first?


It seems to play out fine in my mind. You walk up, feel for a pulse, and look for rise and fall of the chest and listen.

If the person is managing to ventilate on their own, the airway is already open.
If the person is not breathing, you want to correct it.

You check for breathing first because logically there is no need to correct an already open airway.


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## Noncreative (Jul 4, 2015)

benasack2000 said:


> The AHA guidelines for CPR don't include opening the airway before checking for breathing and a carotid pulse. In real life, would I would open the airway BEFORE I check breathing? Why doesn't the AHA include opening the airway first?


Just like start triage, you're checking if they're breathing AND maintaining airway.   If you have to open their airway for them you've got a problem.  Wouldn't be surprised if they add "check 5 sec w/out opening airway"


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