Cardiology and Resuscitation
Recognizing arrest early
The most common error is mistaking agonal gasps for breathing. If the patient is unresponsive and not breathing normally-or only gasping-begin CPR. Check the pulse for no more than 10 seconds; if you are unsure, start compressions.
High-quality CPR
Compressions at 100–120 per minute, depth about 2 inches (5 cm) in an adult, and about one-third the depth of the chest in a child and infant. Allow full recoil, minimize interruptions, and switch compressors every 2 minutes. The single-rescuer ratio is 30:2 for adult, child, and infant; with two rescuers and an advanced airway, give continuous compressions with one breath every 6 seconds. For an infant, use two fingers (single rescuer) or two thumbs encircling (two rescuers) at the nipple line.
AED
Apply the AED as soon as it is available, dry the chest, remove medication patches, and avoid placing pads directly over an implanted device. If the patient is in water, move them out and dry them. For a child under 8 or under about 55 lb, use pediatric pads or an attenuator if available; if not, use adult pads. Clear everyone before shock delivery and resume compressions immediately.
Other cardiac calls
Chest pain: ABCs, oxygen if indicated, position of comfort, and rapid transport. Do not let a patient with chest pain walk to the ambulance. Remember that chest pain may present as jaw, arm, or epigastric discomfort, especially in women, older adults, and diabetics.
Rule of thumb
Unresponsive plus not breathing normally equals CPR-do not delay to look for a pulse you cannot find within 10 seconds.