Out of hospital protocol

Collapsed unresponsive patient Call 911, get AED, start CPR Known asphyxia as cause of arrest 5 cycles of high quality CPR, Call 911, get AED.

Airway

• Open airway using appropriate maneuver (give second attempt if not initially successful to open airway)
• No Trauma: Head tilt/Chin lift
• Trauma: Jaw thrust with inline C-spine immobilization

Breathing; Initial

Confirm patient isn't breathing; then give 2 breaths at 1 second/breath [look for chest rise]. If no chest rise; reposition airway and attempt again. If airway obstructed; abdominal thrusts.

Breathing; CPR ongoing [No advanced airway]

30 compressions then 2 breaths (no compressions during breaths)

Breathing; CPR ongoing [Advanced airway]

100 compressions/min with 8-10 breaths/minute with no pauses for breaths

Breathing; Rescue breathing only

10-12 breaths/minute with pulse recheck every 2 minutes.

Circulation; Pulse check

• Site: Carotid
• Duration: 10 seconds (30-45 seconds if hypothermic)

Circulation; Chest compressions

• Rate/Ratio: 30 compressions then 2 breaths at rate of 100/minute (if advanced airway then 100 compressions/minute with no pauses for 8-10 breaths/minute)
• Technique: Heels of both hands to lower ½ of sternum; push hard and fast, with 1.5-2 inch depth of compression and allow full recoil of chest.
• 2 Rescuer: Rotate compressor role every 2 minutes.
• Focus: Minimize times where there are no chest compressions ongoing; 5 cycles of CPR (approx 2 minutes) before rechecking pulse.

Defibrillation; AED

Provide CPR until AED is connected. Cease CPR when device ready to analyze rhythm. Have AED analyze rhythm.

• Shock Advised: Device will deliver single shock. Continue CPR.
• No Shock Advised: Continue CPR.
• Every 5 cycles (2 minutes) have AED reanalyze rhythm and deliver or not deliver shock; resume CPR. Continue until EMS/Other personal assume care.
• Cease compressions if victim becomes conscious or pulse returns.

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.