Overview

As with all aspects of emergency medicine, it is important to approach basic CPR systematically. When someone is found unresponsive, the following should be performed rapidly and in sequence:

1. Assess responsiveness. If unresponsive, then

2. Obtain assistance/activate the local emergency medical service system.

3. Call for a defibrillator (if available).

4. Position the patient and open the airway (maintain cervical spine immobilization if trauma is potentially involved).

5. Assess breathing. If no breathing is noted, then

6. Give two slow breaths.

7. Assess circulation. If no pulse noted, then

8. Begin closed-chest compressions and continue ventilations. Use the defibrillator if available. Initial Actions

Upon discovery of a collapsed individual, the first medical action should be to assess the victim and determine whether the person is in fact unresponsive. However, prior to approaching a collapsed individual, the scene needs to be fully assessed for dangers to providers. Potential risks, whether from hazardous materials, unstable physical environment, or violence, should be considered. Becoming an additional victim will not aid patients and only add to the work load of other care providers. Once the patient is reached, level of responsiveness can be determined quickly through the administration of various stimuli from mild through noxious. If the individual is not responding, this is the time to obtain help prior to starting ventilations and chest compressions. Within a hospital, this may mean calling for the arrest team and requesting the arrest cart; outside the hospital, this is likely to be activation of the local emergency medical services system. Additionally, efforts should be made to obtain a defibrillator. Time to rhythm-specific therapy, especially defibrillation for unstable ventricular tachycardia or ventricular fibrillation, is critical for the recovery of patients in cardiac arrest.

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