Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e

Chapter 22: Basic Cardiopulmonary Resuscitation

Maite Anna Huis in’t Veld; Jon Mark Hirshon

INTRODUCTION

The time sensitivity of CPR in sudden cardiac death is emphasized in the American Heart Association Chain of Survival (Table 22-1).^1,2 This chapter reviews basic CPR for adults and children ≥8 years old, including the approach to an unresponsive patient; the physiology and mechanics of closed chest compression techniques; and basic airway opening procedures, including initial management of an obstructed airway. This chapter is specifically directed toward healthcare providers, although key updates for lay rescuers are noted, given the healthcare provider’s role in layperson education. Table 22-2 outlines the sequence of steps to be taken when someone is found unresponsive.

TABLE 22-1American Heart Association Chain of Survival^1-4

View Table||Download (.pdf)

TABLE 22-1 American Heart Association Chain of Survival^1-4

Links in Chain

Comment

Recognition and activation of the emergency response system (EMS)

Early recognition of the emergency and activation of the EMS or local emergency response system are vital.

Phone the local emergency medical telephone number.*

Immediate high-quality CPR

Immediate bystander CPR can double or triple the victim’s chance of survival.

Rapid defibrillation

CPR plus defibrillation within 3 to 5 min of collapse can produce improved survival rates.

Basic and advanced emergency medical services

High-quality resuscitative care is provided by EMS personnel.

Advanced life support and postarrest care

High-quality, integrated post–cardiac arrest clinical care by healthcare providers.

*For a global list of emergency numbers and mobile phone use, see https://en.wikipedia.org/wiki/List_of_emergency_telephone_numbers.

TABLE 22-2Systematic Approach to CPR

View Table||Download (.pdf)

TABLE 22-2 Systematic Approach to CPR

CPR Steps

Comments

Step 1: Recognition

Assess for responsiveness, lack of breathing, or presence of abnormal breathing/gasping.

Step 2: Activate the emergency medical response system and get an automatic external defibrillator (AED)

If possible, call for an assistant to activate EMS and obtain an AED.

It is recommended that dispatchers help determine if there is presence of a cardiac arrest and help initiate dispatcher-guided CPR if indicated.

Step 3: Assess circulation (healthcare provider only)

If no pulse after 10-second maximum check, go to step 4. (Pulse checks are for healthcare providers only.)

Step 4: Begin cycle of 30 closed chest compressions

Compressions: “Push hard and fast.”

100–120 compressions/min.

Compress 2–2.5 in. (5–6 cm).

Allow for complete chest recoil, <10-second compression interruption.

Ratio of 30 compressions to 2 breaths.

Alternate compressors every 2 minutes or when the compressor becomes fatigued if an assistant is available.

Step 5: Use the defibrillator when available and indicated

A defibrillator should be used as soon as available.

It is recommended that while the AED is being retrieved and applied CPR is initiated and continued until the device is ready for use.

Step 6: Continue high-quality CPR

Continue CPR between rhythm checks, while the defibrillator is being applied and immediately restart compressions after defibrillation. This is to maximize compression times and decrease ...

Get Free Access Through Your Institution

Learn how to see if your library subscribes to McGraw Hill Medical products.

Subscribe: Institutional or Individual

Sign In

Username

Password

Forgot Password? Forgot Username?

Download the Access App: iOS | Android

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

Chapter 22: Basic Cardiopulmonary Resuscitation

Citation

Jump to a Section

INTRODUCTION

Pop-up div Successfully Displayed

Jump to a Section

INTRODUCTION

Get Free Access Through Your Institution

Sign In

Best of the Blogs

Pop-up div Successfully Displayed