EMT Exam: How to Manage a Cardiac Arrest

By Arthur Hsieh

For the EMT exam, you must know that a heart that beats so weakly that it doesn’t create a pulse or doesn’t contract at all causes the condition known as cardiac arrest. Because there is no blood flow, skin becomes cold and cyanotic (blue), and the patient becomes unresponsive to all stimuli. If cardiac arrest continues for more than a few minutes, enough brain cells die to cause permanent death.

Research in the past decade has shown that effective chest compressions are the foundation of successful resuscitation. In other words, during a “working code” everything that is done revolves around the nonstop, high-quality chest compressions. Keep these points in mind:

  • After checking to see whether the patient is unconscious, spend no more than 10 seconds to confirm there is no carotid pulse and breathing is absent or inadequate (gasping).

  • Begin CPR with compressions, not ventilations. Immediately begin pushing on the chest, while others are assembling other equipment and preparing to ventilate.

  • For adults, administer compressions at a rate of at least 100 per minute, with at least 2 inches of depth, and a full recoil of the chest during release. For pediatric patients, compress the chest at least one-third to one-half the depth of the chest.

  • For adults, space ventilations so two breaths are provided after every 30 compressions. Deliver just enough to make the chest visibly rise. For two-person CPR on a pediatric patient, space ventilations so two breaths are provided after every 15 compressions.

  • Rescuers should switch roles every 2 minutes or 5 cycles of compressions and ventilations, to keep compressions accurate and effective.

  • Apply AED pads as soon as possible.

  • As soon as the pads are applied, everyone stops and the AED is activated. Follow the prompts and make sure everyone stands clear of the patient. After the AED has analyzed, continue compressions while the AED is charging for defibrillation. When the AED is charged, stop compressions, clear the patient, and deliver the shock. Immediately afterward, immediately begin CPR again. Do not pause to check for a pulse.

  • At the end of the next 2-minute interval, look for signs of effective breathing and check for a pulse. If they are absent, immediately resume CPR. If the AED indicates a shock is needed, continue compressions while the AED charges and then clear the patient and deliver the shock.

  • During two-person CPR on a child or infant, the ratio of compressions to ventilations is 15:2. This ratio allows more ventilations to be delivered to the patient.

You and three other trained crew members arrive at a park, where you see a jogger lying on the sidewalk. Two bystanders are performing CPR, with one administering chest compressions while the other is providing mouth-to-mouth ventilations. What should you do next?

  • (A)Stop compressions and check for a radial pulse.

  • (B)Stop compressions and apply the AED pads to the patient’s chest.

  • (C)Have other trained crew members take over compressions and ventilations at the end of a cycle.

  • (D)Apply AED pads during compressions and push the button to analyze when another 5 cycles of compression and ventilations are complete.

The correct choice is (C). You want to minimize interruptions to compressions, and Choice (C) accomplishes this better than Choices (A) and (B). You want to analyze the rhythm as soon as you are able, rather than waiting for 5 cycles of compressions and ventilations to be completed, as Choice (D) indicates.