- Start chest compressions immediately.
- Continuous, good quality compressions improve survival. Keep pauses to an absolute minimum and < 10 seconds.
- Perform compressions at a rate of 100/min.
- Often compressions are too fast.
- Keep them between 80-100 per minute.
- Switch rescuers every two minutes.
- No exceptions; everyone’s compressions deteriorate.
- Do not stop compressions unless absolutely necessary.
- Train to start IV, intubate, during compressions.
- Use PETCO2 to evaluate quality of CPR and to watch for ROSC.
- Both pre- and post-defibrillation pauses are detrimental.
- Charge the defibrillator while providing chest compressions.
- Do not shock during chest compressions; despite what you’ve heard about gloves, it is dangerous.
- Resume chest compressions immediately following defibrillation. Do not check pulse. Check for rhythm change if necessary after at least two minutes have passed.
- Successful defibrillation resets the heart to asystole before resuming a perfusing rhythm.
- Continued chest compressions may increase chance of developing a rhythm and won’t hurt the patient.
- Ventilation is not needed in the first 2-4 minutes after a VF cardiac arrest.
- Agonal breaths signal a reflexive brainstem; these patients may have the best chance of survival.
- Each breath given by positive pressure decreases blood flow to the brain.
- Air pushed into the chest temporarily prevents refilling of the heart.
- Goal of ventilation is maximizing O2 delivery.
- More ventilation/oxygen is NOT better.
- Limit to two breaths after 30 compressions while patient is in arrest or has a SBP <70.
- Use the waveform to adjust ventilation to keep ETCO2 between 35 and 45 mm Hg.
- Spikes in ETCO2 may indicate ROSC.
- Low ETCO2 may be from hyperventilation.
- Expect increased ETC02 following the administration of sodium bicarbonate.
- Ensure that no one ventilates > 6-8/min.
- Consider whether to use the defibrillator in the AED mode.
- To allow CPR analytics, put monitor in paddles lead.