# When taking a pulse



## ArmyofOne1911 (Sep 2, 2011)

When taking a pulse do you count to 60, 30, or 15 seconds?

I was practicing last night and I personally count to thirty and then just multiply that by 2. Should I get in the habit of counting to fifteen and then just multiply the beats by 4?

My math skills aren't great. Multiplying a number by four in my head is also difficult for me to be honest. I know them... I think I just freak myself out. Multiplying a number by 2 in my head is alot easier for me. 

If I stick to taking a pulse for 30 seconds would that be alright? Or do you recommend doing 15 seconds instead. I know every seconds counts. 

Thanks all.


----------



## usafmedic45 (Sep 2, 2011)

It doesn't matter so long as you get the correct answer. Personally I count for 10 and multiply by 6 normally.  If the pulse is irregular, you probably should count for the full sixty though.


----------



## medichopeful (Sep 2, 2011)

ArmyofOne1911 said:


> When taking a pulse do you count to 60, 30, or 15 seconds?
> 
> I was practicing last night and I personally count to thirty and then just multiply that by 2. Should I get in the habit of counting to fifteen and then just multiply the beats by 4?
> 
> ...



I usually count for 15 or 30, then multiply.


----------



## jjesusfreak01 (Sep 2, 2011)

15 seconds, and i'm usually within 4bpm of any other providers vitals, so that's good enough for me.


----------



## ArcticKat (Sep 2, 2011)

If it's regular I count for 15 secs, if it's irregular I count the full minute.


----------



## Anjel (Sep 2, 2011)

ArcticKat said:


> If it's regular I count for 15 secs, if it's irregular I count the full minute.



This.

And dont worry. Multiplying by 4 sometimes throws me off. I always get the right number but sometimes its faster to times my 2. 

Or..... You.can count 15 seconds and multiply by 2 twice. 

Example....

17beats in 15 seconds. 

17x2 is 34. 

34x2 is 68. 

Wah la 68bpm. Lol


----------



## lightsandsirens5 (Sep 2, 2011)

My first pulse I will normally count 10 or 15 seconds. For subsequent ones, if it feels largely the same, I'll count for 6 and then throw a zero on the number I get.


----------



## Tigger (Sep 3, 2011)

If it's a scheduled dialysis patient's second/third set of vitals and they appear to be in reasonably good health, probably not more than 10 seconds. Sometimes only 5 seconds, though LandS15 makes a good point about the counting to six and adding a zero. If we are on an "emergency call" where the patient is actually likely to be somewhat sick, I'm more apt to go for 30 seconds to a minute so as to come up with a good descriptor for the "quality" of the pulse that some triage nurses are known to ask for.


----------



## bigbaldguy (Sep 3, 2011)

I count for 3 minutes and 10 seconds then divide by 3.16.


----------



## usafmedic45 (Sep 3, 2011)

bigbaldguy said:


> I count for 3 minutes and 10 seconds then divide by 3.16.



You, sir, are awesome.


----------



## ArcticKat (Sep 3, 2011)

bigbaldguy said:


> I count for 3 minutes and 10 seconds then divide by 3.16.



Shouldn't that be 3.17?

Too bad it wasn't 3.14, then you could divide by pi.


mmmmmh, pie.

BRB


----------



## Akulahawk (Sep 3, 2011)

I may actually take the pulse rate twice... I might first take it for 6 seconds to get a ball-park figure of fast/normal/slow and I like to see one or two resp cycles in that time, no more or less... again for ball-park fast/normal-ish/slow. I'm not looking for precision: I'm looking for some measure of "do I have to work really really fast?" I normally don't record these vitals for that very reason. It's just a screening tool... Later I'll do a more accurate 15 second (normal-ish), 30 second (abnormal but regular), or 60 second (irregular) for counting the pulse, along with a more formal BP and resp count. 

Sooo... it all just "depends" upon the situation...


----------



## bigbaldguy (Sep 3, 2011)

ArcticKat said:


> Shouldn't that be 3.17?
> 
> Too bad it wasn't 3.14, then you could divide by pi.
> 
> ...



actually its 3.16666667 or some such number but why make it overly complicated.


----------



## DesertMedic66 (Sep 3, 2011)

To the most part I take a pulse right before I take the B/P. I palpate for the artery so I know where my steth should go. I only take the pulse for 15 seconds then x2 and then x2 again. 

When my medic asks for the B/P he likes the pulse to be given at the same time (order of the paperwork). So instead of saying B/P of 122/80 and ummm let me measure pulse really quick, I have both vitals pretty much at the same time.


----------



## ArcticKat (Sep 3, 2011)

bigbaldguy said:


> actually its 3.16666667 or some such number but why make it overly complicated.



I was rounding up. 

mmmh Blueberry Pie.


----------



## JrV (Sep 3, 2011)

ArmyofOne1911 said:


> When taking a pulse do you count to 60, 30, or 15 seconds?
> 
> I was practicing last night and I personally count to thirty and then just multiply that by 2. Should I get in the habit of counting to fifteen and then just multiply the beats by 4?
> 
> ...


When i was taking my courses at the Moreno valley academy we were completeing our skills sign offs for vitals. I started out by doing a full 60 then i stayed at 30.... but then my instructors got on me and said take your vitals quicker, so, i went to 15 and kept practicing. so now i go from 10 to 15 seconds. It really doesnt matter as long as you get an accurate reading.. but i find it easier and faster when your out in the field to get used to doing 10 seconds. You will get accurate readings with plenty of practice


----------



## lightsandsirens5 (Sep 3, 2011)

firefite said:


> To the most part I take a pulse right before I take the B/P. I palpate for the artery so I know where my steth should go. I only take the pulse for 15 seconds then x2 and then x2 again.
> 
> When my medic asks for the B/P he likes the pulse to be given at the same time (order of the paperwork). So instead of saying B/P of 122/80 and ummm let me measure pulse really quick, I have both vitals pretty much at the same time.



I work with a gal occasionally who is somehow able to watch the gauge on the BP cuff, a watch and count beats at the same time. She is thus able to get a pulse and BP simultaneously. It truly is impressive. And I have never known her to get a wrong number. I didn't believe it the first time. But time and again, she proves herself more than able to get dead on numbers every time. Lol. 

But with her you can ask what day a certain date is, and she knows right away. Ie. What is December 3, 2012? And she will answer whatever it is without hesitation. I get the feeling her brain is in some form of over drive while I'm still trying to figure out how to shift mine from first to second. Lol!


----------



## MrBrown (Sep 3, 2011)

Who counts a pulse anymore? Lifepak 12 FTW 

Seriously tho, Brown counts by 15 and mutliplies by 4

Just for the sake of all that is good in the world dont ask Brown to count the respiratory rate!


----------



## lightsandsirens5 (Sep 3, 2011)

MrBrown said:


> Who counts a pulse anymore? Lifepak 12 FTW
> 
> Seriously tho, Brown counts by 15 and mutliplies by 4
> 
> Just for the sake of all that is good in the world dont ask Brown to count the respiratory rate!



Who uses a Lifepak 12 any more...... h34r:






:rofl: Just kidding.....kind of.


----------



## jjesusfreak01 (Sep 3, 2011)

But Brown, how do you use a monitor without a color screen? I don't understand...


----------



## the_negro_puppy (Sep 4, 2011)

I usually count for 10 seconds then multiply by 6. This is can be compare with the pulse ox etc on the LP12 to confirm


----------



## Melclin (Sep 4, 2011)

By 15, multiply it by four if I really wanna know an exact number. 

Often though if I know I'll be monitoring them, or they're not sick enough to worry about haemodynamics too much, I'm, happy with a few seconds then an estimate of slow, normal or fast. I reckon I'm pretty accurate +/- about 10 BPM. I don't suppose that would go over too well during an exam though 




ArcticKat said:


> Shouldn't that be 3.17?
> 
> Too bad it wasn't 3.14, then you could divide by pi.
> 
> ...



That would tickle my temali. I've had an unhealthy obsession with Pi ever since I read Contact by Carl Sagan in grade 4 because my dad told me it was his favourite book. I re read it in Grade 7 and then manually calculated Pi. It took over a 100 calculations to even get the first two decimals accurate. Frustrating.

This was in the same year I won a regional award for the debating team. Yeah I'm not a nerd or anything.


----------



## oneahis (Oct 2, 2011)

I use 15 seconds. If you brain fart you can always double the 15 seconds to 30 and double the 30 to 60. It's a lot easier. Eg.  In 15 seconds you get 23 double it for 46 and double that to get 92. Hope that helps. 


Sent from my iPhone!


----------



## the_negro_puppy (Oct 2, 2011)

oneahis said:


> I use 15 seconds. If you brain fart you can always double the 15 seconds to 30 and double the 30 to 60. It's a lot easier. Eg.  In 15 seconds you get 23 double it for 46 and double that to get 92. Hope that helps.
> 
> 
> Sent from my iPhone!


----------



## traumaluv2011 (Oct 3, 2011)

I use the pulse reading on the pulse ox most of the time. I does the work for me 

It not, I'll actually use 20 seconds times three. The math turns out a little easier than multiplying by four most of the time.


----------



## ArcticKat (Oct 3, 2011)

I'll count for 1 second and multiply by 60. 

It's amazing how much CPR I do.


----------



## Handsome Robb (Oct 3, 2011)

ArcticKat said:


> I'll count for 1 second and multiply by 60.



Permission to steal this method? :rofl:


----------



## Tigger (Oct 3, 2011)

Our issued pulse ox is far too cheap to be of any use in a moving ambulance. Half the time it shows 130+ and grandma has a pulse of 76. Plus I like actually feeling for the pulse and getting something of an inkling of its "quality."


----------



## PotatoMedic (Oct 3, 2011)

the_negro_puppy said:


>



At most I would consider this a "woke from coma" kind of thread...  I was less then a month since last post.  (granted only by a day or two depending on how you count.)


----------



## Handsome Robb (Oct 3, 2011)

Tigger said:


> Our issued pulse ox is far too cheap to be of any use in a moving ambulance.



Our issued pulse ox is ~$35,000 so I tend to trust it. I do agree with feeling the quality or equality though, there's no replacement for a manual palpitation of pulses.


----------



## ArcticKat (Oct 3, 2011)

NVRob said:


> Permission to steal this method? :rofl:



Be my guest.


----------



## slb862 (Oct 3, 2011)

All pulses should be palpated and compared to the rhythm, and pulse ox HR. 

My son had a rapid heart rate that I could only count to 130's a minute, but yet when the HM was placed, his heart rate was in the 200's.  The rest is history and 10s of thousands of dollars later, he is well and it will never occur again. 

I count 15sec and double, then double again. All while watching/and comparing to the monitor.


----------



## Tigger (Oct 4, 2011)

NVRob said:


> Our issued pulse ox is ~$35,000 so I tend to trust it. I do agree with feeling the quality or equality though, there's no replacement for a manual palpitation of pulses.



Reason #804 that working on a BLS truck sucks: no fancy monitor, ever. When a 35k pulse ox/Zoll E series crosses the threshold of my truck, something has gone fairly amiss.

Coincidentally our pulse ox is 35 dollars, so I'm 1/1000 of my way to a monitor!


Sent from my out of area communications device.


----------



## mycrofft (Oct 4, 2011)

*I start palpating as I close with the pt.*

If it's dead regular and I'm hurried, six seconds. If I feel it is even slightly irregular, thirty seconds if I'm pushed, full minute if I have the luxury. I always characterize an irregular pulse as regularly or irregularly irregular, and how many irregular beats occurred (if there ARE any regular beats).  I also characterize strength; as an a-fib pt, even when I have some regular beats, some are much stronger than others; on an EKG, they would be abnormal.


----------



## mint_condition (Oct 4, 2011)

ArmyofOne1911 said:


> My math skills aren't great. Multiplying a number by four in my head is also difficult for me to be honest. I know them... I think I just freak myself out. Multiplying a number by 2 in my head is alot easier for me.



im the same way, i have to sit there and think about it when i multiply by 4, where as if i count for 30 seconds and multiply by 2, i can get my number real easy. AND, if the pulse is irregular, you will have more opportunity to detect this over 30 seconds rather than 15


----------



## hoss42141 (Oct 5, 2011)

I count for 15 sec. and multiply by 4, and then check and see if it is close to the reading on the Lifepak 15. If its close we go with it, if its far off, I got the full 60.


----------



## Lozenger19 (Oct 5, 2011)

I always count for the full 60 seconds


----------



## traumaluv2011 (Oct 5, 2011)

Tigger said:


> Our issued pulse ox is far too cheap to be of any use in a moving ambulance. Half the time it shows 130+ and grandma has a pulse of 76. Plus I like actually feeling for the pulse and getting something of an inkling of its "quality."



Yea for some reason our captain is extremely pro-pulse ox so we have two types of pulse ox devices on the rig we take out for cardiac/breathing related stuff. So we'll take an inital on scene with the tiny unit that like the size of one of those jewelry boxes for rings (you know those proposing boxes), then we'll use the one on our BP/Pulse/SP O2 monitor en route to the hospital.


----------



## traumaluv2011 (Oct 5, 2011)

ArcticKat said:


> I'll count for 1 second and multiply by 60.
> 
> It's amazing how much CPR I do.



Let me guess do you get 60 or 120 every time?


----------



## systemet (Oct 6, 2011)

I count for 13 seconds; square the resulting number, multiply by 21.302, then take the square root of the result.


----------



## LIT (Oct 6, 2011)

The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.


----------



## smilingblueeyes (Oct 6, 2011)

I'm among the ones that push for the full 60 minutes. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'


----------



## hippocratical (Oct 7, 2011)

smilingblueeyes said:


> I'm among the ones that push for the full 60 *minutes.*



If they still have a pulse after that amount of time, your patient is doing at least fairly well!


----------



## medichopeful (Oct 7, 2011)

LIT said:


> The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.



You raise a very good point.  This is especially important when you are counting respirations as well!


----------



## smilingblueeyes (Oct 7, 2011)

hippocratical said:


> If they still have a pulse after that amount of time, your patient is doing at least fairly well!


Oooops. was in the middle of homework. 60 seconds.


----------



## Oiball (Oct 11, 2011)

Minimum 30 seconds, if far out of normal range, take a full 60 seconds.


----------



## the_negro_puppy (Oct 11, 2011)

60 seconds is really not necessary and i'snt really an efficient use of time. In 60 seconds I could have taken a 15 second pulse, got an Sp02 probe on, taken NiBP/ manual BP and done a 6 lead ECG all of which can be used  to obtain a HR. Granted this would be modified for people with irregular heart rates etc but IMHO 60 seconds taking a pulse inst really necceasry. Yes a manual pulse can tell you a wealth of info, but 15-30 seconds should be more than enough.

I guess this will also be different for EMT-Bs etc in the US who dont work using Lifepaks and the like.


----------



## Tigger (Oct 11, 2011)

LIT said:


> The advice we got for skills testing was "if you count to 15 and you are off by only 1-2 beats, when you multiply that by 4 you can end up being off in your final number by at least 4-6 beats. you can't be off by more than 6 beats to pass the skill". Basically the less time you count for, the more you increase your margin of error. Personally based on that reason alone, I count for at least 30. Any less is not accurate or skills test worthy and I feel my patient deserves care at skills testing levels as long as I'm capable of providing it.



Patient's deserve the best level of care possible, but that does not have to be perfectly synonymous with "skills testing levels." Patient's also deserve to be assessed efficiently, and I don't it is efficient to count for 60 seconds in most cases.

Taking a pulse is counting a distinct movement, I don't think many people are going to off by any beats. Even if I am of by 1-2 beats, and the margin of error increases during multiplication, and I end up being six beats off, where does this leave me? Are those six beats going to effect any aspect of my care? Probably not, a pulse is not a fixed number and I've had plenty of stable (IFT) patients whose pulse changed more than six beats during transfer. That does not worry me, it's the body reacting to changes in environment. Now if they really have an irregular pulse I might count for 30-60 sec to confirm that it is irregular. Even if it is irregular, there is nothing I can do to correct it, beyond call for ALS. And if further assessment finds no other abnormalities, I am not calling ALS. 



smilingblueeyes said:


> I'm among the ones that push for the full 60 minutes. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'



Couldn't the rhythm change after taking the pulse for 60 seconds?


----------



## Akulahawk (Oct 11, 2011)

smilingblueeyes said:


> I'm among the ones that push for the full 60 _seconds_. I've been taught that 'Even if you get a normal rhythm, ect, within the first 10/15 seconds, that could very possibly change after you are done with the pulse.'


Fixed it for readability...
I would think that if a rhythm can change after the first few seconds, it could very well change after the first 60 seconds... or for that matter, after 5 minutes of counting.

What I want to truly know is if the basic rate/rhythm is fast, slow, regular, irregular, or irregularly irregular and I can pretty much get that in 15 seconds. If I really absolutely REQUIRE a more exact count of a pulse rate, I'll do it over 30 seconds or a minute, depending upon the actual need. Frankly, I'd rather do a 15 second count for PR and use the next 15 second window to find a convenient start time for me to do a 30 second RR count.


----------



## Shishkabob (Oct 11, 2011)

Like Akula has stated, all that I care about is if it's normal or not.  If not, then is it tachy or brady?  Is it regular or irregular?  More exact numbers can wait till everything else is set.



After that, I check to make sure it matches the monitor and I'm good to go.


----------



## Sasha (Oct 11, 2011)

Agreed. A pulse that can change in 60 seconds could also change in 61. It's just not practical to sit there with your finger on their wrists for the entire transport on the off chance it'll change up in a few seconds.


----------



## Handsome Robb (Oct 11, 2011)

Ever heard of Sinus Dysrhythmia? Pulses tend to vary pretty consistently. Next time someone's on the monitor and you stick an IV check out their rate before and after, 9/10 I'd bet it'll increase. Lots of variables can cause a change in pulse rate.


----------



## BlakeFabian (Oct 16, 2011)

I personally use the 10 sec x6 method. It's easiest for me to multiply in my head.


----------



## ArcticKat (Oct 16, 2011)

NVRob said:


> Ever heard of Sinus Dysrhythmia? Pulses tend to vary pretty consistently. Next time someone's on the monitor and you stick an IV check out their rate before and after, 9/10 I'd bet it'll increase. Lots of variables can cause a change in pulse rate.



That's why they're called Baseline Vitals.  There's always variations in all V/S during a call, but they're going to return to normal after you do the IV poke.  That's why we take serial vitals, if they don't return to normal, look for the cause.


----------



## dfib (Oct 17, 2011)

when i was a new EMT I was so nervous and I used to squeeze the wrist so hard trying to feel a pulse that i would actually act like a tourniquet and couldn't feel a damn thing!


----------



## Handsome Robb (Oct 17, 2011)

ArcticKat said:


> That's why they're called Baseline Vitals.  There's always variations in all V/S during a call, but they're going to return to normal after you do the IV poke.  That's why we take serial vitals, if they don't return to normal, look for the cause.



I agree with you. I was more pointing out the fact that extrinsic factors can cause a change in pulse. You could count for 120 seconds and 99% of the time I'd bet the rate from the first 60 would not match up with the rate from the second 60.


----------



## ArcticKat (Oct 17, 2011)

NVRob said:


> I agree with you. I was more pointing out the fact that extrinsic factors can cause a change in pulse. You could count for 120 seconds and 99% of the time I'd bet the rate from the first 60 would not match up with the rate from the second 60.



Ahhh, I get it now.  I'm a nice boy, just a little slow.

^^If anyone uses that quote in their signature line I'll slap ya.


----------



## Handsome Robb (Oct 17, 2011)

ArcticKat said:


> ^^If anyone uses that quote in their signature line I'll slap ya.



I'm so temped..... :rofl:


----------



## guttruck (Oct 20, 2011)

IMO check for 15sec then multiply x4 during you inital assesment then hook them to your monitor if you have one


----------



## xrsm002 (Nov 6, 2011)

The only problem with a Lifepack 12 of any other vital sign monitor is you can NOT get a "quality" of the pulse...and its not ALWAYS accurate


----------



## Handsome Robb (Nov 6, 2011)

That's why you still manually palpate it and see if it matches the monitor. 

The pulse ox gives you an actual pulse rate too, btw.


----------



## BlakeFabian (Nov 6, 2011)

NVRob said:


> That's why you still manually palpate it and see if it matches the monitor.
> 
> The pulse ox gives you an actual pulse rate too, btw.



I'll trust my monitor before I trust my SA02 monitor, anyday.


----------



## Handsome Robb (Nov 6, 2011)

BlakeFabian said:


> I'll trust my monitor before I trust my SA02 monitor, anyday.



I agree. But technically all the monitor measures is electrical activity, not mechanical. If compared and the mechanical matches the monitor I'll stick with the monitor until something gives me a reason not to.


----------



## usalsfyre (Nov 6, 2011)

Level 6 clinical correlation is seeing if the pleth matches the electrical activity matches the mechanical pulse (be it by art line or palpated).


----------



## usalsfyre (Nov 6, 2011)

BlakeFabian said:


> I'll trust my monitor before I trust my SA02 monitor, anyday.



Minor quibble, unless you've got a prehospital blood gas analyzer, your not measuring SaO2. Your measuring SpO2. SpO2 is a calculation based on light wavelengths. SaO2 is a direct measurement of saturated hemoglobin based on blood analysis. Minor thing, but it keeps you from stupid in front people who know the difference.


----------



## BlakeFabian (Nov 6, 2011)

usalsfyre said:


> Minor quibble, unless you've got a prehospital blood gas analyzer, your not measuring SaO2. Your measuring SpO2. SpO2 is a calculation based on light wavelengths. SaO2 is a direct measurement of saturated hemoglobin based on blood analysis. Minor thing, but it keeps you from stupid in front people who know the difference.



Oh hell, I keep forgetting about that. Haha, you're right. That's what was used all throughout my B & I classes so it got ingrained in my head.  

BTW, you forgot to say 'appearing'


----------



## usalsfyre (Nov 6, 2011)

BlakeFabian said:


> Oh hell, I keep forgetting about that. Haha, you're right. That's what was used all throughout my B & I classes so it got ingrained in my head.
> 
> BTW, you forgot to say 'appearing'



So you've got a quibble too .


----------



## medicnick83 (Nov 17, 2011)

^ hahaha


----------



## BLS Systems Limited (Dec 1, 2011)

Good points all.  Correlation is a great practice to follow as it can identify perfused versus non-perfused beats.  I'll never forget the code I was at where the doc was insisting on defibrillation based on the monitor and we had a strong pleth...so they shocked her just because...


----------



## mycrofft (Dec 1, 2011)

*Anyone still take apical pulses?*

 Taught us to take it apically while palpating radially or elsewhere for best quality.
Plus, do you only/always palpate the radial pulse?


----------

