Safety First: Basic Circulation


Study Notes:

  1. 1.Do they have a pulse?

  2. 2. How fast and strong is it (is there a radial?)

  3. 3. If pulse is absent, start CPR.

  4. 4. If pulse is present, but BP is inadequate transport rapidly.

  5. 5. If pulse is present and adequate, check for gross bleeding

  6. 6. If gross bleeding is present, stop it immediately

  7. 7. If there is no gross bleeding check skin (colour, temperature, condition and turgor – CTCT)

“Primary Circulation”


“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

Blood is better inside.

Next we want to check the patient’s circulation.  There are actually 3 parts of their circulation we want to check.  First of all, do they have any bleeding that can threaten their life (called a ‘gross bleed’, not because it’s disgusting, but because it’s big).  Secondly, do they have a pulse, and, how good is it?  Is it strong or weak?  Finally, what is their skin like?  Are they in shock?

First things first;  we need to make sure that there is a pulse.  If there isn’t a pulse then our patient is clinically dead and we need to start CPR. 

If there is a pulse then we will want to know ‘how good is it’?  One thing we’ll want to know is how fast or slow the pulse is.  Anything between 60-100 is probably good enough for now.  The next thing we’ll want to know is how strong the pulse is.  In particular we want to make sure that the pulse is strong enough to get to the patient’s brain, heart and kidneys (the vital organs).  The fastest and easiest way to do this is to check if they have a radial pulse.  If they have enough blood pressure to perfuse their wrists, then they have enough pressure to perfuse their vital organs, and that’s good enough for now.  If you can’t get a radial you need to either start advanced (paramedic level) care or, if you have only basic life support skills, you need to get the heck out of their and bring your patient to definitive care immediately.  This is a load-and-go situation.

Secondly, we need to check for gross bleeding and stop it if we find it.  This has usually done with dressings and direct pressure, but there are more products coming to market, like Quick Clot® or CELOX® that chemically stop bleeding very quickly and dramatically. Come on synthetic blood!!

After ensuring that there is a pulse, and no gross bleeds, you need to check the patient’s skin.  There is a simple reason for this.  Our body has a biological alarm that it sets off as soon as it realizes that something is wrong.  It would be nice if all of our patients had a siren on their head that told us that their alarm system had been activated, because then it would be easy to see that they are in trouble. The bad news is that our alarm systems are a bit more subtle.  The good news is that they are still pretty easy to see.

When our alarm system (our sympathetic nervous system) is activated it is easily seen on our skin.  The skin becomes pale, cool and slightly sweaty.  When we see this, we know that our patient is in shock.  Imagine a flashing red light on their head saying ‘Warning failure imminent.  Emergency systems activated’.   So when we approach a patient we check the colour, temperature and condition of their skin.

Here’s an easy way to remember to do the circulation check during scenarios.  Stand beside the mannequin with one hand on the patient’s wrist, the back of the other hand on the patient’s forehead, and your eyes staring at their chest.  The hand on the wrist checks the pulse, the hand on the forehead checks the skin and the eyes are a reminder to check for gross bleeds.

One other thing you can check at this point is skin turgor (or ‘tenting’) which can give you an idea of the patient might be dehydrated.

After checking the primary ABC’s it’s time to ...