Cardiopulmonary Resuscitation
1. Call for help. Have an assistant phone 911.
2. Put the person's back on a firm surface to allow for efficient chest compressions.
3. Immediate chest compressions
4. Defibrillate right away if an automatic external defibrillator is available.
The first shock is delivered at 360 or 200 J with a monophasic defibrillator or biphasic defibrillator, respectively.
Defibrillation is for life-threatening arrhythmias
5. Precordial thump if immediate defibrillation not available
6. CPR is immediately resumed after the first shock.2
Give oxygen(?????)
Give 5 cycles of CPR (30 compressions: 2 breathes is one cycle)
Pulse?
Absent 
Present - Post resuscitative care)
Establish Airway
Head tilt, chin lift; jaw thrust if trauma
In an unwitnessed arrest, provide five cycles of CPR ((30 compressions: 2 breathes = One cycle) prior to defibrillation.
This will increase myocardial oxygen and energy substrates, increasing the likelihood of a restoration of spontaneous circulation to the myocardium following defibrillation.1
Begin compressions2
Minimize the preshock pause (the time taken from the last compression to the delivery of shock).1
Compressions: 100/min, 2 inches depth, allow recoil, minimize interruptions. Do not lean hands on the chest between compressions, to allow complete recoil between compressions.
To perform chest compressions, identify the lower sternuym in the center of the chest, between the nipples. The heel of the hand should be in this position, and place the second hand over the first so that they are overlapped and parallel. Compressions should depress the sternum at least 2 in (5 cm) for the average adult, and then allow the chest to return to normal position. Chest recoil allows venous return to the heart.
Breathing: For single rescuer provide chest compression only CPR. This stems from research showing no survival advantage from ventilations during bystander-provided CPR compared to chest compressions only.
Additionally, without interruptions to chest compressions, more blood flow is delivered to vital organs, and mouth-to-mouth resuscitation is thought to be one of the major psychological obstacles to would-be rescuers during a bystander-witnessed arrest.
If second trained rescuer available, 30:2 ratio; with advanced airway, 8–10 breaths per minute
This results in minimal interruption of compressions and blood flow.
Every 2 minutes, reassess, rotate compressors, and resume compressions promptly
Circulation is assessed by palpation of the carotid pulse.
If a pulse is present, rescue breathing can continue with one breath every 5–6 seconds.
If a pulse is absent, re-start chest compressions.
Intravenous Access
Administer: Epinephrine 1 mg iv every 3-5 minutes
Amiodorone for refractory: Dose
Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen:
-Loading infusions: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min)
-Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min)
Maintenance dose: After the first 24 hours, continue the maintenance infusion rate of 0.5 mg/min; may increase infusion rate to achieve effective arrhythmia suppression.
-Supplemental infusions: 150 mg over 10 minutes (15 mg/min) for breakthrough episodes of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT)
Maximum dose: Initial infusion rate: 30 mg/min
Duration of therapy: Until ventricular arrhythmias stabilize (most patients require 48 to 96 hours); maintenance infusion of up to 0.5 mg/min can be continued for up to 3 weeks.
Comments: Mean daily doses greater than 2100 mg for the first 24 hours were associated with increased risk of hypotension.
Use: Initiation of treatment and prophylaxis of frequently recurring VF and hemodynamically unstable VT in patients refractory to other therapy.
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| CPR Steps | Comments |
|---|---|
| Step 1: Recognition | Assess for responsiveness, lack of breathing, or presence of abnormal breathing/gasping. |
| Step 2: Activate the emergency medical response system and get an automatic external defibrillator (AED) | If possible, call for an assistant to activate EMS and obtain an AED. It is recommended that dispatchers help determine if there is presence of a cardiac arrest and help initiate dispatcher-guided CPR if indicated. |
| Step 3: Assess circulation (healthcare provider only) | If no pulse after 10-second maximum check, go to step 4. (Pulse checks are for healthcare providers only.) |
| Step 4: Begin cycle of 30 closed chest compressions | Compressions: “Push hard and fast.” 100–120 compressions/min. Compress 2–2.5 in. (5–6 cm). Allow for complete chest recoil, <10-second compression interruption. Ratio of 30 compressions to 2 breaths. Alternate compressors every 2 minutes or when the compressor becomes fatigued if an assistant is available. |
| Step 5: Use the defibrillator when available and indicated | A defibrillator should be used as soon as available. It is recommended that while the AED is being retrieved and applied CPR is initiated and continued until the device is ready for use. |
| Step 6: Continue high-quality CPR | Continue CPR between rhythm checks, while the defibrillator is being applied and immediately restart compressions after defibrillation. This is to maximize compression times and decrease interruptions. |
| Step 7: Rescue breathing | Rescue breaths are to be initiated only by a trained lay rescuer that is able to perform rescue breaths or by a healthcare provider. Untrained lay rescuers and trained lay rescuers unable to provide rescue breaths should perform compression-only CPR. Administer 2 breaths following a cycle of 30 chest compressions. Deliver each breath over 1 second with sufficient tidal volume to see a visible chest rise. Continue cycles of 30 closed chest compressions and 2 breaths, minimizing interruptions. |
*For a global list of emergency numbers and mobile phone use, see https://en.wikipedia.org/wiki/List_of_emergency_telephone_numbers.