*Person Collapses (Adult, assume cardiac arrest)
*Assess Responsiveness (Shake and Shout or if trauma, Touch and Talk
to pt) "Are you awake?"
*Activate emergency response system (call 911 or if in a medical setting
call a code blue or call for a defibrillator) - the main rhythm
associated with cardiac arrest in an adult is V.fib/Pulseless V. Tach
and NEEDS to be shocked as soon as possible to survive.
Begin the Primary Survey
A=Airway, Open and assess airway. Use head tilt-chin lift or if trauma suspected jaw thrust method to open the airway. Look (for chest rise), listen (over the mouth for air movement), and feel (for breathing against our face). Treat occasional gasps as if not breathing. The new guidelines recommend that if in the field and ALONE (one person), open all airways by head tilt-chin lift. The rationale is that one person doing a jaw thrust will need to stay and maintain that head positioning. It is more of a priority to open the airway and breath for the patient than it is to maintain the head in proper alignment.
B=Breathing, take 5-10 seconds to check for breathing. If none, give 2 slow breaths over 1 second and enough to cause visible chest rise. If the first does not go in, reposition the head (reopen the airway) and try again.
C=Circulation, Assess pulse and skin color and movement from pt for signs of circulation. If no carotid pulse within 10 seconds, start Chest Compressions hard (1 1/2 to 2 inches) and fast (100 compressions per minute). (Give 30 chest compressions for every 2 breaths for two minutes, then switch). If there is a pulse, still rescue breathe for the pt 10-12 times per minute. Give a breath enough to cause chest rise and complete recoil.
Automated External Defibrillator (AED) is available. (Now is not the time to learn to use your AED, so make sure your familiar with the equipment and trouble shooting common problems).
D=Defibrillation, follow directions from the AED.
Quick steps:
Turn on
Attach electrodes to the patient and machine
Clear to Analyze
Clear to Shock
1. It cannot be automated unless it is turned on. Some AEDs can be turned on by lifting the lid. Some have an "ON" button or switch.
2. Attach electrodes to the patient following the diagram on the AED pads. Remove medication patches and wipe away with a cloth, not your direct hand as the medication could affect you. Some medications such as Nitroglycerin could be a fire hazard. Some long term medications could be damaged and give their full dose. All could interrupt the shock if underneath the AED pad. Avoid implanted devices by 1 inch. Wipe off a wet patient's chest. Avoid hair. If extra AED pads are available and hair is still causing interruptions, then remove the AED pads (this will strip most of the hair off) and place new AED pads on the patient.
3. Press "Analyze." Remember to stop CPR while AED is trying to analyze. Follow directions if it tells you to shock. If it does not, then resume CPR.
4. Defibrillate 1 time if needed for persistent Ventricular Fibrillation (V. Fib.) or Ventricular Tachycardia (V. Tach.), 120 - 200Joules(J) - biphasic or 360J - monophasic (200J, 200-300J, 360J is still programmed into many AEDs). While some AEDs will still have the escalating doses of biphasic or monophasic shocks, there is no evidence to support stacked shocks over one single shock. **Remember it is your responsibility to make sure no one touches the patient and no oxygen source is near the chest of the patient. Call out "I'm clear! Your clear! Everyone clear!"**
5. Don't stop to check for a pulse if rhythm unchanged. Do CPR for 2 minutes at 30:2 - 30 compressions to 2 ventilations.
6. Hit "Analyze" again and follow directions from the AED.
Defibrillate 120-200J-biphasic or 360J monophasic.
7. Recheck pulse only if organized rhythm changes or other apparent signs of responsiveness changes, do CPR for 2 minutes.
8. Continue this pattern until EMS arrives or a crash cart arrives to continue with the secondary survey ABCD.
