Two studies since the 2010 AHA Guidelines failed to identify an optimal alternative hand placement position for closed chest massage in adults. Over the years, recommendations for hand positioning when performing chest compressions have migrated from two fingers above the tip of the xiphoid process to the lower half of the breastbone. The original recommendation for where to place the hands when performing chest compressions comes from canine studies extrapolated to humans. If the pulse is absent or you are unsure if the pulse is present, begin chest compressions. Do not spend more than 10 seconds checking for a pulse. In many instances, health care providers also take too long to make a decision. Because health care providers often have difficulty determining whether a pulse is present, withhold chest compressions only when absolutely sure the pulse is present. Simultaneously during the breathing assessment, check the patient's carotid artery to verify pulselessness. Gasping is associated with increased survival to discharge rates. However, when the EMS response time was greater than nine minutes, only 7 percent of the patients were still gasping. In one study, EMS responders witnessed gasping in about 20 percent of patients when the EMS response time was less than seven minutes. Gasping occurs frequently in patients who develop sudden cardiac arrest, but rapidly disappears as time progresses. ĭo not confuse gasping with normal breathing. Unresponsive patients who are not breathing normally have a high likelihood of being in cardiac arrest. Determine whether the patient is breathing normally. Upon contact with the victim, verify unresponsiveness and send someone to get an AED or manual defibrillator. A team of responders can therefore accomplish multiple tasks simultaneously.Īpproach the victim cautiously, making sure the scene is safe before proceeding. Although one of the limitations of any patient care algorithm is the linear presentation of the steps, the AHA acknowledges that EMS responses rarely involve a single person. Most of the sequential assessments and actions for CPR remain unchanged from the 2010 recommendations. The recommendation is for the EMD to provide compression-only instruction until EMS arrival. The AHA states that after identification of an unconscious adult patient with abnormal or absent breathing, it is reasonable for the EMD to assume the patient is in cardiac arrest. In the OOH environment, the emergency medical dispatcher (EMD) plays a key role in the chain of survival once the bystander accesses the EMS system. Thus, the 2015 recommendation is for hospitals to implement MET responses based on early warning signs. Multiple studies since the release of the 2010 AHA Guidelines demonstrate a decrease in the incidence of in-hospital cardiac arrest when hospitals implemented a system of medical emergency team (MET) responses to patients with signs of impending cardiac arrest. Prompt recognition of those warning signs and appropriate intervention could possibly prevent the cardiac arrest from occurring in the first place.ĪHA CPR guidelines: What the 2015 PALS updates mean for EMS providers In many of these cases, patients display clear warning signs of impending cardiac arrest. Without those early interventions, the chances of survival decrease.Īlthough early CPR and defibrillation still have value for cardiac arrest occurring in the in-hospital setting, those initial responders are often health care providers with some degree of professional training. The role of the lay rescuer is significantly more important in the OOH setting where, ideally the patient receives CPR and defibrillation before the EMS team arrives on the scene. The AHA continues to recognize the relevancy of the Chain of Survival however, it recognizes the important differences between responding to a cardiac arrest in the out-of-hospital (OOH) environment and responding to an arrest that occurs inside the hospital. However, in other cases, the AHA made recommendations that did not previously exist. In many cases, the AHA did not significantly change previous recommendations but simply clarified meanings. This publication represents the most current recommendations for improving survival from cardiac arrest. In October of 2015, the American Heart Association released the 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).
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