Medically reviewed by Dr. Payal Kohli, M.D., FACC — Written by April Kahn — Updated on August 16, 2019
- What to look for
- Causes
- Treatment
- Complications
- Takeaway
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Your pulse is the rate at which your heart beats. It can be felt at different pulse points on your body, such as your wrist, neck, or groin.
When a person is seriously injured or ill, it may be hard to feel their pulse. When their pulse is absent, you can’t feel it at all.
A weak or absent pulse is considered a medical emergency. Usually, this symptom indicates a serious problem in the body. A person with a weak or absent pulse will often have difficulty moving or speaking. If someone has this condition, call 911 immediately.
You can identify a weak or absent pulse by checking a pulse point on someone’s wrist or neck. It’s important to check the pulse correctly. Otherwise, you could mistakenly report a weak pulse. Follow these instructions to check each pulse point:
- Wrist: Place your index and middle fingers on the underside of their wrist, below the base of their thumb. Make sure to press firmly.
- Neck: Place your index and middle fingers next to their Adam’s apple, in the soft hollow area. Make sure to press firmly.
If you identify a weak or absent pulse in someone, call 911 immediately.
Once you find their pulse, count the beats for one full minute. Or count the beats for 30 seconds and multiply by two. This will give you their beats per minute. A normal resting heart rate for adults is 60 to 100 beats per minute.
You should also assess the regularity of the pulse. A regular pulse, meaning your heart beats at a consistent pace, is considered normal, whereas an irregular pulse is considered abnormal.
Some people may normally have a weak pulse. In this case, equipment can be used to measure their pulse properly. One type of equipment is a pulse oximeter. This is a small monitor placed on someone’s fingertip to measure the oxygen levels in their body.
Related issues
Other symptoms may be present with a weak or absent pulse. These symptoms include:
The most common causes for a weak or absent pulse are cardiac arrest and shock. Cardiac arrest occurs when someone’s heart stops beating.
Shock happens when blood flow is reduced to vital organs. This causes a weak pulse, rapid heartbeat, shallow breathing, and unconsciousness.
Shock can be caused by anything from dehydration, infection, severe allergy attack to a heart attack.
If someone has a weak or absent pulse and no effective heartbeat, you should perform cardiopulmonary resuscitation (CPR).
Before beginning, determine whether the person is conscious or unconscious. If you’re not sure, tap on their shoulder or chest and ask loudly, “Are you OK?”
If there’s no response and a phone is handy, call 911. If someone else is available, ask them to call 911 for you. If you’re alone and the person is unresponsive because of suffocation — for example, from drowning — perform hands-only CPR for one minute. Then call 911.
To give chest compressions:
- Lay the person on a firm surface. Don’t move them if it looks like they might have a spinal injury or head injury.
- Kneel down beside the person’s chest.
- Place one of your hands on the center of their chest, and place your other hand on top of the first.
- Lean in with your shoulders, and apply pressure to the person’s chest by pushing down at least 2 inches. Make sure your hands are positioned in the center of the person’s chest.
- Count one, and then release the pressure. Keep doing these compressions at the rate of 100 per minute until the person shows signs of life or until paramedics arrive.
In 2018, the American Heart Association released updated guidelines for CPR. If you’re not trained in CPR but would like to be, call your local Red Cross for information on classes in your area.
Follow-up care
At the hospital, the person’s doctor will use pulse-monitoring equipment to measure their pulse. If there’s no effective heartbeat or the person isn’t breathing, emergency staff will administer appropriate care to restore their vital signs.
Once the cause is discovered, their doctor will prescribe necessary medications. Or they may give a list of things to avoid, such as foods that cause allergic reactions.
If necessary, the person will follow up with their primary care doctor.
A person may have bruised or fractured ribs if they received CPR. If their breathing or heartbeat stopped for a significant amount of time, they may have organ damage. Organ damage can be caused by tissue death from lack of oxygen.
More serious complications may occur if they had no effective heartbeat and their pulse wasn’t restored quickly enough. These complications can include:
- coma, caused by lack of blood and oxygen to the brain, typically following cardiac arrest
- shock, caused by insufficient blood pressure to the vital organs
- death, caused by lack of circulation and oxygen to the heart muscle
A weak or absent pulse can be a serious problem. Call 911 if someone has a weak or absent pulse and is struggling to move or speak. Getting treatment quickly can help prevent any complications.
Last medically reviewed on August 14, 2019
thready pulse
A small fine pulse, feeling like a small cord or thread under the finger.
Synonym: pulsus filiformis.
I was asked, “Would you describe that pulse as thready?”
I have never had a good grasp of what is meant by “thready” or “bounding” as those terms seem very subjective. I think most EMS professionals could come to agreement on what fast, slow, regular, or irregular means. But I have yet to come to a good understanding of what is meant by thready, bounding, or even strong. Even weak and strong seem like they could be a function of palpation and proximity of the radial artery to the skin.
How do you define thready or bounding to a new EMT or paramedic student?
Many pulse oximeters provide a pulse bar or pleth (plethysmograph); however this information has been largely ignored by most users even when it provides some very important information signals. The pulse bar or pleth is a graphical representation of how your heart beats; although it does not give you a set of numbers, it gives you an indication of your general health and heart conditions. Here we will discuss how and why you should pay attention to this signal.
It is difficult to have one guideline for all people as the pulse is dependent on many variables, such as age, gender, circadian rhythm, body build, stress and emotions, exercise and activities, body temperature... It is important to establish a norm for you at various situations, such as resting after meal or during rigorous exercise. Then pay attention for any deviation from your norm. If you have any questions, ask your doctor.
Pulse assessment has been used in various degrees in medical field. In western medicine, pulse assessment is commonly performed by palpating the pulse at the wrist or listening to the heart beats at the chest with a stethoscope. In oriental medicine, palpation on the wrist is the primary method used. Pulse diagnosis plays an important role in the history of Chinese medicine.
Features of a pulse
When assessing a patient's pulse, there are three important factors; pulse rate, pulse strength and or volume, and pulse rhythm. All three of these factors can be observed through the pulse bar or pleth displayed by an oximeter.
Pulse rate
For a normal adult and under normal conditions, the heart rate ranges from 60 to 100 beats per minute (bpm). For well-trained athletes, the heart rate can go as low as 40bpm.
Tachycardia is a heart condition that causes the heart to beat in excess of 100 bpm. Rapid contraction, if sustained, tends to overwork the heart and reduce blood circulation leading to low blood oxygen saturation level. For this condition medical treatment is required.
Bradycardia is a heart condition with heart beats below 60bpm. Unless you are an athlete, this would merit continued monitoring as bradycardia can be caused by some issues with the heart's electrical system.
Pulse strength (volume)
Pulse strength or volume is related the amount of blood pumped with each heartbeat or the force associated with each contraction. A normal pulse is one that can be felt with mild pressure on the artery. A thready pulse or weak pulse is one that is difficult to feel or obliterated easily with slight pressure. A full or bounding pulse has a pronounced pulsation that does not easily disappear with pressure. A rapid thready pulse is normally a sign of serious concern and must be reported immediately. There are different ways to classify the pulse strength. The following table shows one particular approach.
| 0 | None | No pulsation is felt with extreme pressure |
| 1 | Thready | Not easily felt; disappear under slight pressure |
| 2 | Weak | Stronger than thready; disappear under light pressure |
| 3 | Normal | Easily felt; disappear under moderate pressure |
| 4 | Bounding | Strong and does not disappear with moderate pressure |
With a pulse oximeter, similar information can be observed from the amplitude of the pleth wave or the fluctuation in the pulse bar. In order to establish a point of reference you can try to get a reading from several people to see what the various patterns look like.
For weak or thready pulses, some oximeters may have trouble getting a reading. It would be a good idea to double check the readings.
Pulse rhythm
The pulse rhythm is the pattern of pulsations, amplitude, and the pauses between each pulse. They should be regular and consistent from beat to beat. An arrhythmia or dysrhythmia (irregular patterns) is cause for serious concern and should be treated by medical professionals as soon as possible. An electrocardiogram should be performed for further clarification.