BLS / ACLS common mistakes
BLS / ACLS · Understand the traps and how to avoid them.
Treats agonal gasps as normal breathing and delays calling for help or starting compressions.
Agonal gasps are common in the first minutes of cardiac arrest and can look like breathing; candidates may wait for a 'better' assessment or assume the patient is not in arrest.
What to do instead
Teach and apply the rule: if the adult is unresponsive and not breathing normally, start CPR immediately and send someone for an AED; count agonal gasps as 'not breathing normally' and do not delay.
Compresses outside the 100–120/min rate or at inadequate depth (less than 5 cm in an adult, less than one-third AP chest depth in a child or infant).
Adrenaline and counting errors push candidates to compress too fast; without visual or auditory feedback, depth and rate drift.
What to do instead
Use a metronome or CPR feedback device, count aloud, and coach to 100–120/min with 5–6 cm adult depth and at least one-third AP chest depth in children and infants; allow full chest recoil between compressions.
Interrupts chest compressions for more than 10 seconds during pulse checks, rhythm analysis, pad placement, or compressor changes.
No one owns the timer, pulses are checked too long, and pads are applied only after compressions stop instead of during ongoing CPR.
What to do instead
Assign a timer/recorder role, limit rhythm and pulse checks to 10 seconds or less, switch compressors during the rhythm check, and prepare AED pads and monitor leads while compressions continue.
Ventilates too fast or with too much volume with a bag-mask device, including extra breaths during 30:2 or more than 1 breath every 6 seconds after an advanced airway is placed.
Candidates equate more oxygen with better resuscitation and squeeze the bag fully and frequently; anxiety also speeds delivery.
What to do instead
Give just enough volume for visible chest rise, deliver 1 breath every 6 seconds with an advanced airway, avoid hyperventilation, and use a timer or feedback device to enforce the rate.
Delays defibrillation to continue CPR, or delivers a shock without a loud 'clear' command and visual check that no one is touching the patient; does not resume compressions immediately after the shock.
Unclear team command and fear of injury cause hesitation; the team may not have practiced coordinated charging during compressions.
What to do instead
Charge the AED while compressions continue, announce 'clear' loudly, visually confirm everyone is clear, deliver the shock, and immediately resume compressions without a pulse check.
Mistakes fine ventricular fibrillation or monitor artifact for asystole and withholds a shock, or shocks an organized rhythm.
Limited rhythm exposure and failure to check lead connection, gain, or a second lead make fine VF and artifact look like asystole or vice versa.
What to do instead
Confirm the rhythm with adequate gain and a second lead when uncertain, treat VF/pVT with immediate defibrillation, and confirm asystole only after checking leads and gain.
Gives epinephrine at the wrong interval or gives amiodarone before the third shock in refractory VF/pVT.
Algorithm sequencing is memorized as a list rather than as timed actions, and the team lacks a single timekeeper.
What to do instead
Give epinephrine every 3–5 minutes, give amiodarone after the third shock for refractory VF/pVT, and assign a timekeeper or use a code checklist to track drug intervals.
Gives orders without naming the receiver, fails to confirm that the order was heard, and allows overlapping or unassigned roles.
High-stress resuscitation and hierarchy suppress closed-loop communication; team members assume someone else is performing the task.
What to do instead
Use closed-loop communication: name the person, state the order, require a verbal confirmation, and have the team leader assign and verbalize roles before or at the start of the resuscitation.
After return of spontaneous circulation, titrates oxygen to 100% SpO2 or continues hyperventilation.
Fear of recurrent hypoxia and routine use of 100% oxygen lead to hyperoxia and hypocapnia, which can worsen reperfusion injury and cerebral blood flow.
What to do instead
Titrate oxygen to an SpO2 of 92–98%, avoid hyperoxia, target PaCO2 of 35–45 mm Hg, and use waveform capnography to guide ventilation.
Fails to ask and document the time last known well in a suspected stroke, or delays obtaining a 12-lead ECG beyond 10 minutes in suspected ACS.
Attention is focused on symptom control and transport, and stroke or ACS time-critical steps are not built into the initial assessment.
What to do instead
Ask 'When was the patient last known well?' and activate the stroke protocol immediately; obtain and interpret a 12-lead ECG within 10 minutes of arrival for suspected ACS and give aspirin if not contraindicated.