Vissia S. Pinili, MSN, RN, CPAN, CCRN, Nicole R. Keller, PharmD, BCNSP and Glenn N. Levine, MD, FACC, FAHA

1. Why was the A-B-C (airway, breathing, compression) sequence of cardiopulmonary resuscitation (CPR) changed to C-A-B (compression, airway, breathing)?

    According to American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC), chest compression were often delayed while the rescuer opened the airway to give mouth-to-mouth breaths, retrieved a barrier device, or gathered and assembled ventilation equipment. Starting the resuscitation sequence with chest compressions is also hoped to encourage more persons to initiate CPR.

2. What factors constitute “high-quality CPR”?

    Components of high-quality CPR include:

3. What is your first step if you are alone and come across an unresponsive adult victim with no signs of breathing?

    Activate the emergency response system and get an automated external defibrillator (AED), if available in the area, then return to the victim. If you return with an AED, turn it on and follow the prompt. If no AED is available, check for a pulse and begin CPR until emergency medical services (EMS) arrives to take over.

    Figure 39-1 is an algorithm for adult basic life support (BLS) decisions and actions. A summary of key BLS components for treating adults, children, and infants is given in Table 39-1.

4. For patients with respiratory arrest (but with a perfusing heart rhythm), how often should breaths be delivered?

    For respiratory arrest with a perfusion cardiac rhythm, breaths should be delivered every 5 to 6 seconds (10-12 breaths/min).

5. What is the most common cause of airway obstruction in the unconscious adult patient?

    In adults the most common cause of airway obstruction in an unconscious patient is loss of tone in the throat muscles, leading to airway occlusion by the tongue. This may be treated by head tilt–chin lift, jaw thrust, or insertion of an oropharyngeal airway.

6. How many joules of energy are indicated for the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) when using a biphasic defibrillator?

    Biphasic defibrillators are now used at many institutions, replacing the older monophasic defibrillators. The amount of energy will often be device specific, ranging from 120 to 200 J. If the appropriate setting is unknown, use 200 J. Additional shocks should be equivalent or higher energy. This contrasts to the older monophasic defibrillators, for which a setting of 360 J is recommended.

7. In order, what are the preferred routes of drug administration?

 Intravenous (IV) is the preferred route of drug administration. The guidelines emphasize that resuscitation attempts should not be delayed by trying to achieve central IV access when peripheral IV access can be easily achieved.

 When IV access is not possible, intraosseous (IO) is preferred over endotracheal (ET). The IO route can be used in both children and adults.

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