In clinical practice, healthcare providers assess a pulse as a fundamental skill to evaluate heart rate, rhythm, and local arterial patency. A pulse occurs when the left ventricle of the heart contracts, sending a wave of blood through the arterial system. While clinicians utilize the radial artery most commonly, they must identify several other locations—known as pulse points—for a comprehensive physical examination.
The following guide details the primary pulse points of the human body, categorizing them by anatomical location and clinical significance.
Primary Cranial and Cervical Pulse Sites
The upper portion of the body contains vital sites used often in emergency or specialized assessments.
- Temporal Pulse: This is located on the sides of the forehead (temples). Clinicians frequently assess this point when they cannot access the radial pulse or when they perform specific neurological evaluations.
- Carotid Pulse: Found on both sides of the neck, right below the jawline. The carotid artery is the most reliable site for pulse detection during emergency situations, such as cardiac arrest, as it is the last peripheral pulse to disappear.
Central and Upper Extremity Sites
Moving toward the torso and arms, these sites are critical for pediatric care and blood pressure monitoring.
- Apical Pulse: Unlike peripheral pulses, this is located at the apex of the heart. It is typically auscultated with a stethoscope rather than palpated. This site is considered the most accurate for measuring cardiac rhythm.
- Brachial Pulse: Located at the inner elbow (antecubital fossa). Clinicians use this site primarily to measure blood pressure and prefer it when checking pulses in infants.
- Radial Pulse: Situated on the thumb side of the wrist. Because of its accessibility, clinicians use this site most frequently to monitor routine vital signs in adults.
Lower Extremity Pulse Sites
Assessment of the lower extremities is vital for diagnosing Peripheral Artery Disease (PAD) or ensuring adequate circulation after a procedure.
- Femoral Pulse: Located in the groin area, between the pubic bone and the anterior iliac crest. Medical teams utilize this major artery to assess patients during severe trauma or to perform cardiac catheterization.
- Popliteal Pulse: Found behind the knee. This pulse can be more difficult to palpate and often requires the patient to slightly flex the knee.
- Posterior Tibial Pulse: Located at the inner ankle, just below the medial malleolus (ankle bone).
- Dorsalis Pedis Pulse: Found on the top of the foot, specifically between the first and second toes. This site is essential for evaluating distal circulation in the lower limbs.
Why Pulse Assessment Matters
The systematic evaluation of these points allows healthcare providers to identify irregularities in blood flow or vascular health. For instance, if a radial pulse is weak, the brachial or carotid sites are often checked to confirm central perfusion.
Clinical Note: When palpating a pulse, the thumb should never be used, as it has its own strong pulsation which may lead to an inaccurate heart rate reading.