Chapter 39: Ready for Review
 Use the links in the Chain of Survival as a guide to manage cardiac arrest: recognition of
a cardiac emergency, early access to 9-1-1, early high-quality CPR by the public or
responders, early defibrillation, early advanced life support care, and transport to a
hospital that can provide state-of-the-art post-resuscitative care.
 Both the 2005 and 2010 CPR guidelines emphasize the importance of providing highquality CPR beginning with compressions (push hard and fast, and allow full chest
recoil).
 Advanced airways are only considered during the field code if a basic airway is not
adequate or the airway needs to be better protected due to a patient who is vomiting. The
focus of care should be CPR with high-quality compressions.
 The basic principles of BLS are the same for infants, children, and adults. According to
the American Heart Association (AHA), anyone between the ages of 1 month and 1 year
is considered an infant. A child is between age 1 year and puberty. Adulthood is from
onset of puberty and older.
 You must first assess the patient’s circulation. If the patient has no pulse, you must
provide artificial circulation by beginning with chest compressions at the rate and depth
appropriate for the patient’s age.
 CPR can be performed with one or two rescuers. Two-rescuer CPR or a team approach is
always the first choice. When a rescuer is performing adult CPR alone or with another
rescuer, the ratio of compressions to ventilations is 30:2.
 Defibrillation needs to be carried out as soon as possible in the presence of two
rhythms—ventricular fibrillation and pulseless ventricular tachycardia—because the
likelihood of its success declines rapidly with time.
 When you use a manual defibrillator, you interpret the cardiac rhythm and determine if
defibrillation is needed. An automated external defibrillator interprets the cardiac rhythm
for you and determines if defibrillation is indicated.
 Defibrillation is indicated for patients in nontraumatic cardiac arrest who are older than 1
month. If you are using an automated external defibrillator on a child between age 1 year
and the onset of puberty, if available, you should use pediatric-sized pads and a doseattenuating system (energy reducer).
 The ACLS algorithm separates the treatment approach into two basic pathways:
shockable rhythms (ventricular fibrillation or ventricular tachycardia) or nonshockable
rhythms (asystole or pulseless electrical activity).
 For all arrests, regardless of the rhythm, you should consider the reversible causes and
treat them as appropriate.
 For asystole or pulseless electrical activity, do not deliver shocks.
 Certain devices may be used as adjuncts to circulation to help improve the quality of
compressions when you are providing CPR. These devices include the impedance
threshold device, the mechanical piston device, and the load-distributing band.
 For postresuscitative care, if an effective cardiac rhythm is restored in the field, transport
immediately. However, if the patient is comatose after ROSC, consider hypothermia
treatment depending on protocol.
 Terminating resuscitative efforts in an adult with a prehospital cardiac arrest should
follow the ALS termination of resuscitation rule.
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Teamwork divides tasks while multiplying the chances for a successful resuscitation.
Whether you are a code team member or a code team leader, you should know both your
own role and the roles of the other members of your code team during the resuscitation
attempt.