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Chest Compressions

Answer: C

This woman has experienced a witnessed cardiac arrest.  The 2010 guidelines emphasize good quality CPR – this was such an issue that the priorities are now Compressions-Airway-Breathing (C-A-B).  In adult arrest, the cause is primarily cardiac.  The brain and heart must be perfused immediately; it is estimated that there is a 7-10% per minute mortality in cardiac arrest without CPR or resuscitative efforts.

It is always correct to start with the basics and to remember the fundamentals of BLS.  However, due to the new emphasis on the urgency of compressions, “look, listen, and feel” has been eliminated from the guidelines (A).  In a similar light, checking for a pulse (for health care providers) has been curtailed to a maximum of 10 seconds; if there is no definite pulse in a non-responsive patient who is not breathing or only gasping, initiate compressions immediately (B) at a rate of 30 compressions to 2 rescue breaths (whether there are one or two rescuers) (D). (As an aside, PALS guidelines call for a ratio of 30:2 for a lone rescuer, 15:2 if there are two rescuers).  Once an advanced airway is established, compressions and breaths are not coordinated; administer continuous compressions and ventilate at 8-10 per minute – ventilate over one second, until there is visible chest rise.

Once electrodes are placed on the patient, manual pads are available or an AED is available, CPR is briefly held for a pulse and rhythm check, and the ACLS algorithm is followed.   Compressions should be at a rate of at least 100/minute and to 1/3 of the anterior-posterior chest diameter (≥ 5 cm in adults) – “push hard, push fast” (C).

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