7 Once the defibrillation has occurred, compressions should be commenced straight away with no pause to assess the outcome of the shock.
#Do you shock pulseless electrical activity manual#
The new recommended procedure when using a manual defibrillator with pads for contact is to charge the defibrillator while compressions continue and only stop compressions when it is fully charged and ready to defibrillate. The new advanced life support guidelines also support continuous CPR, with a change to the recommendations surrounding charging and discharging a manual defibrillator. Importantly, in the basic life support guidelines all reference to checking a pulse has been dropped on the basis that patients who are not responsive and not breathing normally are highly likely to be in arrest and will not be harmed by compressions if these are commenced unnecessarily. Australian Resuscitation Council advanced life support for adults algorithm 5 In one South Australian study, under half of the patients in cardiac arrest received CPR, which represents a significant missed opportunity. 4 Some authors recommend advising bystanders and first responders to use compression only CPR in the first instance on the basis that this will increase the percentage of patients receiving CPR. This change in policy from ventilation first recognises that compression only cardiopulmonary resuscitation (CPR) is significantly better than no CPR. The rescuer then should consider two ventilations for every 30 compressions, if they are willing and able. 4 The description 'not breathing normally' means that, even if the person still has agonal respiratory effort, compressions should be started quickly. The guidelines support starting compressions on any person who is not responsive and not breathing normally. In the new ARC basic life support guidelines, the value of providing ventilation at all is considered discretionary. Over the years, compression to ventilation ratios have changed from five compressions to one ventilation, to 30 compressions to two ventilations.
Guidelines have attempted to reflect this by reducing or eliminating as much as possible any gaps in compression. Whenever there is a break in compressions to allow ventilation or to perform some other manoeuvre, the pressure within the aorta drops. Importance of compressionsĬontinuous compressions allow a build-up of pressure in the aorta, which in turn maintains flow to both the myocardium and the brain. The key messages from the new guidelines are about recognising the importance of compressions, simplifying drug regimens and emphasising the importance of postresuscitation care. In December 2010, the latest guidelines were released in Australia for implementation in 2011 3 ( Figure 1, 2). 2 The Australian Resuscitation Council (ARC), in conjunction with the New Zealand Resuscitation Council, contributes to this process on behalf of the Pacific region. Every 5 years the International Liaison Committee on Resuscitation (ILCOR) assesses the latest evidence evaluated by an international body of experts interested in resuscitation and issues updated guidelines.
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