Cardiopulmonary Resuscitation (CPR)

The ABC basic life support for cardiac arrest can be followed, but ideally DRSABCD should be followed: assess Dangers, assess Response, Send for help, open Airway, Breaths, Chest compression and Defibrillation (if available and required).

Basic life support The following represents a logical plan for the adult patient who collapses or is found apparently unconscious.

1. Shake and shout at the patient.

2. Check breathing.

3. Finger sweep oropharynx (clear it).

4. Check pulse (feel carotid adjacent to thyroid cartilage).

5. Call for help (if no pulse), e.g. phone 000.

6. Place victim on back on firm surface.

7. Thump precordium (if arrest witnessed).

8. Tilt head back (to maximum).

9. Lift chin (use airway if available).

Basic life support:

• rescue breaths—2 deep breaths

• external chest compression (no pause)—30 compressions

• continue alternating 30 compressions (rate 100–120/min) with 2 strong breaths.

Note: The ratio of 30:2 with 1 or 2 rescuers is now favoured but check ILCORE guidelines (www.ilcor.org). Some authorities advocate continuous compression. In adults, depth of compression is 4–5 cm, 4 cm above xiphisternum.

Advanced life support

Optimal initial support involves:

• endotracheal intubation (otherwise bag and oxygen)

• ECG monitoring

• intravenous access (large peripheral or central vein)

• continuing chest compression

Optimal initial therapy involves:

• defibrillation

• oxygen

• cardioactive drugs, esp. adrenaline

Give a single shock instead of stacked shocks for VF (pulseless VT).

Where the arrest is witnessed by a health professional and a manual defibrillator is available, then up to 3 shocks may be given (stacked shock strategy) at the first defibrillation attempt.

After each defibrillation attempt, give 2 mins of CPR before checking rhythm and pulse.