CPR, Temperature Emergencies and Unexpected Responses

Cardiopulmonary Resuscitation and Defibrillation Across the Lifespan

Cardiopulmonary resuscitation follows the standardized sequence of Chest compressions, Airway, and Breathing (C-A-B). For suspected cardiac arrest, the practical nurse assesses responsiveness and breathing, checks the pulse for no more than 10 seconds, calls for help and an AED, and begins compressions when indicated; choking and respiratory arrest require different initial actions. For an unresponsive adult, check the carotid pulse for at least 5 but no more than 10 seconds. In an unresponsive child, check the carotid or femoral pulse for at least 5 but no more than 10 seconds. For an unresponsive infant, assess the brachial artery pulse for the same duration of at least 5 but no more than 10 seconds. If no pulse is detected, begin chest compressions without delay; for an infant or child, also begin compressions if the heart rate remains below 60/min with signs of poor perfusion despite effective oxygenation and ventilation.

High-quality chest compressions require proper speed, depth, and technique. Across all clients, deliver compressions at a rate of 100 to 120 compressions per minute and minimize interruptions to less than 10 seconds. For an adult, compress to a depth of at least 2 inches (5 cm), but do not exceed 2.4 inches (6 cm). For a child, compress to a depth of about 2 inches (5 cm), or at least one-third the anteroposterior diameter of the chest. For an infant, compress to a depth of about 1.5 inches (4 cm), or at least one-third the anteroposterior diameter of the chest. Rescuers must permit complete chest wall recoil between compressions to allow venous return and ventricular filling.

Compression-to-ventilation ratios vary based on the number of rescuers and the age of the client. A single rescuer uses a 30:2 ratio for adult, child, and infant CPR. When two rescuers assist a child or infant, the ratio shifts to 15:2. An automated external defibrillator (AED) must be powered on immediately upon its arrival, and the rescuer must follow the voice prompts. For an adult, attach the pads to the upper right chest below the clavicle and the lower left chest below the axilla. Prepare the skin properly by wiping away moisture and removing excessive chest hair only if it prevents pad adhesion, taking care not to delay defibrillation unnecessarily. If a transdermal medication patch covers a pad site, remove the patch and wipe the skin before applying the pad.

Safety during defibrillation is essential to prevent injury and maintain perfusion. Rescuers must clear the area and ensure no one touches the client during AED rhythm analysis and shock delivery. Immediately after the AED delivers a shock, the practical nurse and team resume chest compressions without pausing to check a pulse. Compressions should restart right away to keep blood flowing to vital organs.