You are called emergent to an 86-year-old male at a nursing home. Staff state they do not perform CPR due to liability. You find the patient unconscious, unresponsive, and not breathing.
1. Move the patient to a hard surface and begin ventilations before any other step
2. Apply the AED and deliver a shock before beginning chest compressions
3. Quickly look for a valid DNR or POLST; if none is present or known, start CPR immediately
4. Ask the staff for the family's wishes and wait for them to arrive before acting
Answer: Staff reluctance is not a valid order. A DNR must be verified quickly, but if none is available the standard of care is immediate CPR.
No DNR is found. After 2 minutes of CPR, you apply the AED and the monitor shows ventricular fibrillation.
1. Clear the patient and deliver a shock with the AED, then resume compressions immediately
2. Start transcutaneous pacing to capture a perfusing rhythm
3. Continue compressions and give 1 mg of epinephrine IV before the first shock
4. Deliver synchronized cardioversion at 100 J to avoid damaging the chest wall
Answer: Ventricular fibrillation is treated with unsynchronized defibrillation as soon as it is identified. Drugs do not replace the shock, and cardioversion and pacing are not used for pulseless rhythms.
1. Check for a pulse for up to 10 seconds to confirm conversion
2. Deliver two breaths and then reassess the rhythm
3. Resume chest compressions for 2 minutes before the next rhythm or pulse check
4. Pause for 30 seconds to allow the rhythm to stabilize on the monitor
Answer: Resuming compressions immediately minimizes the pause and supports the heart after a shock. Early pulse checks and prolonged pauses reduce coronary and cerebral perfusion.
1. Rate of 100 to 120 per minute, depth of at least 2 inches (5 cm), full recoil, 30:2 without an advanced airway
2. Rate of 100 to 120 per minute, depth of 1.5 inches, 30:2 without an advanced airway
3. Rate of 120 to 140 per minute, depth of at least 2 inches, 15:2 without an advanced airway
4. Rate of 80 to 100 per minute, depth of 1 to 1.5 inches, 15:2 without an advanced airway
Answer: AHA adult high-quality CPR is 100 to 120 per minute at a depth of at least 2 inches (about 5 cm, not more than 2.4 inches) with full chest recoil and a 30:2 ratio until an advanced airway is placed.
1. Transport immediately and hold CPR to reduce the time to the receiving hospital
2. Pronounce death on scene because the patient is over 85 years old and in refractory VF
3. Continue CPR and AED cycles, request ALS, and address reversible causes per protocol
4. Stop resuscitation after the third shock because the rhythm is considered refractory
Answer: Persistent VF requires continued high-quality CPR, ALS, and consideration of reversible causes (the H's and T's). Termination decisions follow protocol and medical direction, not age or a fixed number of shocks.