Adult Cardiac Arrest Management (BLS)
Basic Life Support for cardiac arrest in out-of-hospital settings
⚠️ Do NOT start CPR if: Valid DNR order OR patient is "obviously dead"
Obviously Dead Criteria
- Decapitation, transection, decomposition, or putrefaction
- Absent vital signs AND one or more of:
- Grossly charred body
- Open torso/head wound with gross outpouring of contents
- Rigor mortis
- Dependent lividity
Priority Actions
- Call dispatch or 911 for assistance
- Assess ABC and confirm pulselessness
- Start CPR and attach AED
- Confirm type of arrest (medical, trauma, hypothermia, foreign body)
- Take brief history from bystanders if available
Timeline Information to Gather
- Time last seen well
- Time of cardiac arrest/collapse
- Time CPR started (bystander or first responder)
- Time of first defibrillation
- Total number of defibrillations
- Presenting rhythm (if known)
- Progression of rhythms
- Time of ROSC (return of spontaneous circulation)
Treatment by Scope
SFA, FR, EMR, and up
- Start CPR and attach AED pads; follow commands
- Insert oral airway
- 30 compressions to 2 breaths
PCP, RPN, LPN, RN, and up
- Start CPR, attach AED or manual pads & monitor
- Analyze rhythm; if VT or VF, charge and shock
- Continue compressions during charging, then shock
- Perform high-efficiency CPR, minimize interruptions
- Analyze rhythm every 2 minutes
- Defibrillate in escalating doses (see below)
- Insert oral or nasal airway ASAP - 30:2 ratio
- Insert King Tube if prolonged arrest - switch to 1 breath every 6 seconds
ACP, RN (EM/CC)
Follow current ACLS protocols/HLC directives
Manual Defibrillation Doses
| Monitor | Escalating Doses |
|---|---|
| Zoll | 120J → 150J → 200J |
| Lifepack | 200J → 300J → 360J |
King Tube - Do NOT Use If:
- Unable to clear airway
- Active vomiting
- Ingestion of caustic substance
- Airway edema
- Stridor
High-Quality CPR Checklist
- Compressions: Center of chest
- Depth: At least 2 inches (5 cm)
- Rate: 100-120 per minute
- Allow full chest recoil between compressions
- Minimize interruptions in chest compressions
- Ratio: 30 compressions : 2 breaths (or continuous compressions with advanced airway)
⚠️ AED Use: Use AED as soon as available. Follow device prompts. Continue CPR between AED analysis/shock cycles.
Source: Odyssey Medical Consulting
Version: 2023-01-17