A 54-year-old man collapses suddenly in the hospital cafeteria. He is unresponsive, apneic, and has no palpable pulse. A bystander has just brought an automated external defibrillator (AED) and the cardiac monitor pads are applied. The monitor displays coarse ventricular fibrillation. Arrange the following interventions in the most appropriate chronological sequence for the initial management of this patient according to standard advanced cardiac life support (ACLS) guidelines.
- 1Initiate high-quality chest compressions
- 2Deliver an unsynchronized defibrillation shock
- 3Immediately resume chest compressions for 2 minutes
- 4Obtain intravenous access and administer epinephrine
Answer
The correct sequence is to first initiate chest compressions, followed by an unsynchronized shock, then immediate resumption of chest compressions for 2 minutes, and finally the administration of epinephrine if the patient remains in cardiac arrest.
In the management of witnessed cardiac arrest due to ventricular fibrillation, high-quality CPR is the immediate priority. As soon as the defibrillator is ready, an unsynchronized shock should be delivered to terminate the disorganized rhythm. Following the shock, CPR must be resumed immediately for 2 minutes without pausing to check the rhythm, as the stunned myocardium requires time to regain mechanical function. Only after this cycle, while CPR continues, should intravenous access be established and epinephrine administered to improve coronary perfusion pressure.
Step-by-Step Solution
Key Concept
Advanced Cardiac Life Support (ACLS) Pulseless Arrest Algorithm for Shockable Rhythms