A 58-year-old man collapses in the hospital lobby. A nearby physician confirms he is unresponsive, apneic, and lacks a palpable carotid pulse. A resuscitation team arrives immediately with a crash cart, and the initial cardiac monitor displays coarse ventricular fibrillation. Arrange the following interventions in the correct chronological sequence according to standard Advanced Cardiac Life Support (ACLS) guidelines for adult cardiac arrest.
- 1Initiate high-quality cardiopulmonary resuscitation (CPR) and attach the defibrillator pads.
- 2Deliver a single unsynchronized shock.
- 3Immediately resume high-quality CPR for 2 minutes and establish intravenous or intraosseous access.
- 4Perform a rhythm check, deliver a second shock if indicated, and administer intravenous epinephrine.
Answer
The correct sequence for managing ventricular fibrillation is to first initiate CPR and attach the defibrillator, then deliver an immediate shock, followed immediately by 2 minutes of CPR while obtaining IV/IO access, and finally performing a rhythm check with subsequent epinephrine administration if the rhythm remains shockable.
The Advanced Cardiac Life Support algorithm dictates a strict sequence to maximize survival in shockable cardiac arrests (ventricular fibrillation and pulseless ventricular tachycardia). The sequence must begin with high-quality CPR and defibrillator attachment. Once a shockable rhythm is confirmed, the immediate next step is a single unsynchronized shock. Following the shock, providers must immediately resume CPR for 2 minutes without pausing for a rhythm check, during which time intravenous or intraosseous access should be established. Only after these 2 minutes of CPR is another rhythm check performed; if the rhythm remains shockable, another shock is delivered, followed by the administration of 1 mg of epinephrine.
Step-by-Step Solution
Key Concept
Advanced Cardiac Life Support (ACLS) Ventricular Fibrillation Algorithm
Estimated Time:1m 0s