Cardiac arrest and immediate life support

Why this matters on day one

You will attend arrests from your first week. As the most junior person there you are unlikely to lead, but you will be doing compressions, gaining access, drawing up drugs and giving the history — and the history is often the thing that identifies the reversible cause.

The sequence

1. 1Confirm and call. Unresponsive and not breathing normally (agonal gasps are not breathing) → call the arrest team, get the defibrillator, start compressions. Do not spend time on a prolonged pulse check.
2. 2Compressions. Centre of the chest, 5–6 cm deep, 100–120/min, full recoil, minimal interruptions. Swap the compressor every two minutes — quality falls before you feel tired. Ratio 30:2 until an advanced airway is in, then continuous.
3. 3Rhythm. Shockable (VF/pulseless VT) → defibrillate immediately, resume compressions at once, adrenaline 1 mg IV and amiodarone 300 mg after the THIRD shock. Non-shockable (asystole/PEA) → adrenaline 1 mg IV as soon as access is available, then every 3–5 minutes (alternate cycles).
4. 4Reversible causes. The 4 Hs: hypoxia, hypovolaemia, hypo/hyperkalaemia and metabolic, hypothermia. The 4 Ts: thrombosis (coronary or pulmonary), tension pneumothorax, tamponade, toxins. Say them out loud — as the person holding the notes you may be the only one who knows about the potassium of 6.9 this morning.
5. 5After. Post-ROSC: ABCDE, target saturations 94–98%, ECG, arterial line and critical care transfer. Then the debrief — attend it, and take the offer of support seriously.

What goes wrong

• Interrupting compressions for rhythm checks, intubation or line placement. Interruptions cost survival.
• Shocking asystole, or delaying adrenaline in PEA waiting for a shock.
• Giving amiodarone before the third shock.
• Not looking at the notes and drug chart. The reversible cause is often already documented.
• Forgetting there may be a valid DNACPR or ReSPECT decision — check, quickly, and stop if resuscitation is not in the plan.