Protective eye wear, gloves, and when necessary, water-impervious gowns and footwear are used when available
Shout for help; have them call 911
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Obtain defibrillator; when available, attach and activate
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Begin CAB resuscitation (compressions, airway, breathing)
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Compressions: 100/min, 2 inches depth, allow recoil, minimize interruptions
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Airway: Head tilt, chin lift; jaw thrust if trauma
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Breathing: Compressions only; if second trained rescuer available, 30:2 ratio; with advanced airway, 8–10 breaths per minute
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- Every 2 minutes, reassess, rotate compressors, and resume compressions promptly
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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.
Adult Advanced Cardiac Life Support
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Cardiac arrest
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Activate emergency response
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Begin CPR while obtaining rhythm assessment
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Non-shockable rhythm (asystole, pulseless electrical activity)
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CPR 2-minute cycles
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Give epinephrine every 3–5 minutes
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Reassess for shockable rhythm at end of each CPR cycle
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Treat reversible causes
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Shockable rhythm (ventricular fibrillation, pulseless ventricular tachycardia)
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Shock
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Resume CPR immediately, 2-minute cycles
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Reassess for shockable rhythm at end of each CPR cycle; shock if appropriate
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Give epinephrine every 3–5 minutes
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Consider amiodarone or lidocaine if no ROSC after epinephrine and shock
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Treat reversible causes
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ROSC: Begin postarrest care
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Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive summary. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S315–S367. [http://circ.ahajournals.org/content/132/18_suppl_2/S315]