Cardiac Arrest and BLS

• Athlete with witnessed collapse

  1. Check responsiveness

  2. Tap shoulder and ask, "Are you alright?"

  3. If unresponsive, maintain high suspicion of SCA
• Lone rescuer


  1. Activate EMS (phone 911)

  2. Obtain AED, if readily available

  3. Return to victim to use AED and begin CPR
• Multiple rescuers


  1. Rescuer 1: Begin CPR

  2. Rescuer 2: Activate EMS (phone 911)

  3. Rescuer 2 or 3: Obtain AED, if available
• Apply AED and turn on for rhythm analysis


  As soon as possible in any collapsed and unresponsive athlete
• Open airway and check breathing

  1. Head tilt-chin lift maneuver

  2. Look, listen, and feel

  3. Is normal breathing present?

  4. Normal breathing not detected, assume SCA

  5. Give 2 rescue breaths

  6. Produce visible chest rise
• Health care providers only

  1. Check pulse (< 10 sec)

  2. No pulse

  3. Definitive pulse

  4. Give 1 breath every 5 seconds

  5. Recheck pulse frequently
• Begin chest compressions


  1. Push hard, push fast (100/minute)

  2. Depress sternum 5 cm

  3. Allow complete chest recoil

  4. Give cycles of 30 compressions and 2 breaths

  5. Continue until AED/defibrillator arrives

  6. Minimize interruptions in chest compressions
• AED/defibrillator arrives


  1. Apply and check rhythm

  2. Shock advised: Give 1 shock and resume immediate CPR beginning with chest compressions

  3. Recheck rhythm every 5 cycles of CPR

  4. Minimize interruptions in chest compressions

  5. Continue until advanced life support providers take over or victim starts to move
• No shock advised


  1. Recheck rhythm every 5 cycles of CPR

  2. Minimize interruptions in chest compressions

  3. Continue until advanced life support providers take over or victim starts to move
• Features of quality chest compressions

  1. Compressions should be administered at a rate of at least 100 compressions per minute

  2. Compressions should be done to a depth of at least 2 inches (5 centimeters)

  3. Hand position should be on the center of the chest and allow for full recoil

  4. No pauses between compression cycles should be allowed

  5. No unnecessary movements or bouncing should be done
• The Reversible causes of Cardiac arrest: 4 Hs and 4Ts

  Hypo xia

  Hypo volemia

  Hypo/ Hyper kalemia

  Hypo thermia

   

  Tension pneumothorax

  Tamponade

  Toxins

  Thrombosis
• Drugs routinely used in cardiac arrest:

  • adrenaline (epinephrine): should be given to all patients in cardiac arrest every 5 min; it has both α- and β-adrenergic effects, resulting in vasoconstriction and increased venous return as well as increasing heart rate
  • atropine : blocks the parasympathetic action of the vagus nerve and may increase heart rate
  • amiodarone : may be of use in refractory ventricular arrhythmias.
• Top priorities in cardiac arrest management

  • Prompt identification of cardiac arrest
  • High quality CPR with minimal interruptions
  • Early defibrillation in shockable rhythms (VT and VF)
  • Identify and treat any reversible causes of cardiac arrest (4Hs and 4Ts)
• Ventricular fibrillation


  Ventricular fibrillation appears on a rhythm strip as chaotic and disorganised electrical activity with no identifiable QRS complexes. VF is initially coarse and will progress to fine VF and eventually asystole if prompt defibrillation is not performed. 

  
• Ventricular tachycardia

  VT appears as a regular broad complex tachycardia, typically between 100-300 bpm.

  It is important to check for a pulse when this rhythm is seen. VT with a pulse is managed according to the ALS tachycardia algorithm. Torsade de pointes is a subtype of polymorphic VT where the axis of electrical activity rotates in a sinusoidal pattern.

  
• Pulseless electrical activity

  Pulseless electrical activity is defined as the absence of a pulse in a patient with electrical activity that would normally be expected to produce a cardiac output.

  Causes of PEA include severe fluid depletion or blood loss, cardiac tamponade, massive pulmonary embolism and tension pneumothorax.

  
• Asystole

  Asystole describes the absence of electrical activity on the rhythm strip. This is rarely a completely flat line, as slight undulations are usually seen with additional interference from ventilation and chest compressions.

  If a completely flat line is seen, ensure the monitoring is attached correctly.