Immediate Management of Sudden Loss of Consciousness with Pulselessness

Initial Assessment and Recognition

The American Heart Association recommends verifying scene safety before approaching the patient to avoid becoming a second victim 1, 2
The American Heart Association suggests checking for responsiveness by shouting and tapping the victim 1, 2
The American Heart Association advises activating the emergency response system immediately and retrieving an AED (or sending someone to do so if multiple rescuers are present) 1
The American Heart Association recommends simultaneously assessing breathing and pulse within 10 seconds—looking for no breathing or only gasping while checking for a pulse 1, 2

The American Heart Association recommends performing chest compressions at a depth of 5-6 cm (at least 2 inches) in adults at a rate of 100-120 compressions per minute 1, 2
The American Heart Association suggests allowing complete chest recoil between compressions—incomplete chest recoil prevents full cardiac refilling and is a critical error 1, 2
The American Heart Association advises minimizing interruptions in chest compressions, as continuous compressions are essential for survival 1, 2
The American Heart Association recommends using a compression-to-ventilation ratio of 30:2 for single rescuers (30 compressions followed by 2 breaths) 1, 2
For untrained rescuers, the American Heart Association suggests that compression-only CPR is acceptable and should be encouraged over no CPR 1

The American Heart Association recommends using the AED as soon as it becomes available—do not delay CPR to retrieve it, but apply it immediately once present 1, 2
The American Heart Association suggests checking the rhythm to determine if it is shockable (ventricular fibrillation or pulseless ventricular tachycardia) 1, 2
The American Heart Association advises delivering one shock immediately if the rhythm is shockable and resuming CPR for 2 minutes before reassessing the rhythm 1, 2

The American Heart Association recommends checking rhythm every 2 minutes during CPR 1
The American Heart Association suggests administering epinephrine every 3-5 minutes for all cardiac arrest rhythms 1
The American Heart Association advises considering amiodarone or lidocaine for refractory ventricular fibrillation or pulseless ventricular tachycardia 1

For pediatric patients, the American Heart Association recommends using a compression-to-ventilation ratio of 30:2 for single rescuers and 15:2 for two or more rescuers 3, 4, 5
For pediatric patients, the American Heart Association suggests that compressions should be at least one-third of the anterior-posterior diameter of the chest 5
For suspected opioid overdose, the American Heart Association recommends administering naloxone if available while continuing CPR 1

The American Heart Association advises not delaying CPR to obtain a detailed history—the priority is immediate chest compressions 1
The American Heart Association suggests not performing prolonged pulse checks—if uncertain after 10 seconds, start CPR 1
The American Heart Association recommends not providing inadequate compression depth or rate—compressions must be hard and fast to be effective 1, 2
The American Heart Association advises not leaning on the chest between compressions—this prevents adequate cardiac refilling 1