A 56-year-old man comes to the physician because of a chest and epigastric discomfort since this morning. While sitting in the waiting area, he suddenly becomes unresponsive. He has scarce respiratory efforts and there is no palpable pulse over the carotid arteries.
Which of the following is the most appropriate next step in managing this patient?

Question

A 56-year-old man comes to the physician because of a chest and epigastric discomfort since this morning.  While sitting in the waiting area, he suddenly becomes unresponsive.  He has scarce respiratory efforts and there is no palpable pulse over the carotid arteries.
Which of the following is the most appropriate next step in managing this patient?

Quizplus · Accepted Answer

Current BLS/ACLS guidelines changed the order for treating cardiac arrest patients from "ABC" (i.e., Airway, Breathing, and Circulation) to "CAB" (i.e., Chest compressions, Airway, and Breathing). The timing and quality of chest compressions is the most important predictor of survival after cardiac arrest. Effective chest compressions are defined as proper depth (5 cm or 2 inches), rate (100/min), and with complete chest recoil. Opening the airway and delivering rescue breaths has taken a secondary role after beginning chest compressions, which should not be interrupted once started (Choice A). Cardiopulmonary resuscitation (CPR) should be initiated and compressions continued until the shock is ready to be delivered for patients with ventricular fibrillation. Certain pulseless rhythms (asystole and pulseless electrical activity) do not need defibrillation (Choice C). Other vital interventions (e.g., tracheal intubation, intravenous access, monitors, and medications to treat arrhythmias) should be done either during chest compressions or during the briefest possible interruption (Choices B & E). Educational objective: The timing and quality of chest compressions is the most important predictor of survival in cardiac arrest patients and should be the first action. Compressions are continued until the shock is ready to be delivered for patients with ventricular fibrillation. Subsequent important maneuvers (e.g., intubation, IV access, etc.) should be done either during chest compressions, after a full cycle, or during the briefest possible interruption. __________ References: Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (http://www.ncbi.nlm.nih.gov/pubmed/20956224) Advanced Cardiac Life Support guidelines 2011. (http://www.ncbi.nlm.nih.gov/pubmed/21879211)

A 56-Year-Old Man Comes to the Physician Because of a Chest