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The algorithms and guidelines of the American Heart Association (AHA) and International Liaison Committee on Cardiac Resuscitation (ILCOR) have been updated. The latest guidelines promote the use of automatic external defibrillator (AEDs) by emergency medical services (EMS), police, and the general public. The establishment of public access defibrillator (PAD) programs and continued development of EMS protocols make it necessary for receiving physicians in emergency departments to be knowledgeable in the current recommendations of the AHA regarding the use of the prehospital AEDs. These recommendations can be found in the most current Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2005.*

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According to the latest AHA guidelines, if a person experiences witnessed sudden cardiac death (cardiac arrest) and a defibrillator or an AED is available, defibrillation should be performed as soon as possible. However, if a person is “found down” and may have been unresponsive for several minutes, ∼ 5 cycles (∼ 2 min) of CPR should be performed before initiation of defibrillation.

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People who experience cardiac arrest and receive immediate defibrillation are more likely to be successfully defibrillated after the first shock. For every minute of circulatory arrest there is an ∼ 10% decrease in the likelihood of successful resuscitation. Patients who are subject to delays in receiving resuscitation do not fare as well, unless there has been a brief period of CPR before defibrillation.

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Many communities, organizations, and EMS systems participate in PAD programs. These programs facilitate early recognition and management by the use of AEDs, and some hospitals have AEDs available, so that a patient who “arrests” can be defibrillated before the arrival of the code team.

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Many patients who experience sudden cardiac death due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) can be defibrillated before they arrive at the hospital. That the rescuer does not have to interpret the cardiac rhythm may increase the chance of survival by markedly decreasing time to “first shock.” New guidelines for resuscitation stress timely defibrillation and early, consistent chest compressions with minimal interruption.

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Children often experience VF after respiratory arrest. It is reasonable that CPR be performed (5 cycles/2 min) before defibrillation is attempted, unless the child suddenly collapses. In that case, the AED should be applied as soon as it is available.

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*2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(24 suppl). Available online at: http://circ.ahajournals.org/content/vol112/24_suppl (accessed 01/04/2007).

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CPR Basics: ABCs (Airway, Breathing, Circulation)

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Universal precautions dictate that protective eye wear, gloves, and when necessary, water-impervious gowns and footwear be used. All patients must have a patent airway, be breathing, and have signs of spontaneous circulation.Figure 21–1 shows the basic life support (BLS) algorithm. The new guidelines differentiate resuscitation by nonprofessional rescuers from resuscitation by health care providers.

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