pulselessness

Pulselessness is the absence of a detectable arterial pulse, indicating reduced perfusion or cardiac output. It can be detected in peripheral arteries such as the radial or femoral arteries, or in central arteries such as the carotid. In clinical practice, absence of a palpable pulse is a critical sign that prompts rapid assessment for life-threatening conditions.

Causes include cardiac arrest from myocardial infarction or arrhythmia, severe bradycardia or tachyarrhythmia, massive hemorrhage and hypovolemia, distributive shock, cardiac tamponade, tension pneumothorax, pulmonary embolism, and acute arterial occlusion. Conditions with diminished cardiac output or extreme vasodilation can also produce pulselessness.

Assessment involves careful palpation of pulses and measurement of blood pressure, along with evaluation of mental status and skin perfusion. In emergency settings, pulselessness is treated as a life-threatening sign that requires urgent medical evaluation to determine and address the underlying cause and to restore perfusion as possible.

Clinical implications vary by context. In the setting of cardiac arrest, pulselessness is a defining sign and carries a guarded prognosis that depends on rapid, skilled intervention and resuscitation. Peripheral pulselessness may reflect local arterial occlusion, severe hypotension, or systemic shock.

Prognosis depends on the underlying cause, duration of compromised perfusion, and the promptness of treatment; some etiologies are reversible with timely care, whereas prolonged pulselessness portends greater risk of organ injury or death.