A 60-year-old man suddenly collapses while walking in the hospital lobby. He is found to be unresponsive, pulseless, and apneic. Bystanders immediately begin high-quality chest compressions. An automated external defibrillator (AED) is attached, and the rhythm monitor displays ventricular fibrillation. Arrange the following subsequent interventions in the correct chronological order according to standard Advanced Cardiovascular Life Support (ACLS) guidelines.
- 1Deliver the first unsynchronized defibrillation shock.
- 2Immediately resume continuous chest compressions for 2 minutes.
- 3Perform a rhythm check and deliver a second shock if ventricular fibrillation persists.
- 4Administer 1 mg of intravenous epinephrine while continuing CPR.
Cevap
The correct sequence is to first deliver an unsynchronized shock, immediately resume chest compressions for 2 minutes, perform a rhythm check to deliver a second shock if indicated, and finally administer intravenous epinephrine.
The Advanced Cardiovascular Life Support (ACLS) protocol for a shockable pulseless arrest (ventricular fibrillation or pulseless ventricular tachycardia) strictly prioritizes early defibrillation and high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions. Once ventricular fibrillation is identified on the monitor, the immediate next step is to deliver a shock. Immediately following the shock, chest compressions must be resumed for 2 minutes without pausing for a rhythm or pulse check. After this 2-minute cycle, a rhythm check is performed; if ventricular fibrillation persists, a second shock is delivered. Pharmacotherapy, specifically 1 mg of epinephrine, is then incorporated into the algorithm during the subsequent CPR cycle.
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Advanced Cardiovascular Life Support (ACLS) Ventricular Fibrillation Protocol
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