Adult resuscitation summary.

Life support is a chain of events and therapies that follow the victim from the initial recognition of cardiac arrest to advanced in-hospital therapies following their resuscitation. The AHA has named this the ‘‘Chain of Survival.’’ Like any chain there are separate links, or steps, that must be connected by providers to form the chain from start to finish. To lean on the metaphor somewhat more, if any link in that chain is weak, or missing, the outcome for the patient will likely be less than what it could be, if all the links were strong. The following pages will go on to elucidate the links in the chain (both BLS and ACLS), and highlight many of the pertinent finer points that providers should be aware of. We will also specifically address the important changes from previous care recommendations. The first link in the chain of survival is immediate recognition of sudden cardiac arrest and activation of emergency response system (ERS). Upon witnessing an unresponsive or recently collapsed victim, providers should first ensure a safe scene by looking for obvious hazards, which may bring danger upon themselves. An unprepared rescuer can quickly become a second victim if an area is not properly secured. For example, moving a victim away from a busy intersection will delay the second link, but will be far safer than initiating that step near street traffic. Next, providers should check for response by stimulating the victim. Common and acceptable methods are verbal (shouting in the ear) and tactile (forceful sternal rub). Even after a normal response to stimulation, and certainly if the victim is unresponsive, providers should promptly activate the emergency response system (EMS). This can be done by a single provider with a phone, or by designating another bystander to call 911. In the situation that a lone rescuer finds the victim, it is recommended that 5 rounds of CPR be given prior to seeking out help if a phone is not on hand. The second link in the chain of survival is to provide early high-quality CPR (Fig. 1). There are different recommendations for lay providers and experienced healthcare professionals. If victim is unresponsive or not breathing normally (gasping), the lay provider should assume victim is in cardiac arrest. Lay rescuers should not perform pulse checks. After calling EMS, the rescuer should immediately begin CPR or prepare to receive instructions for CPR from the dispatcher. Lay rescuers should not provide rescue breaths unless asphyxiation is suspected. If asphyxiation is suspected, or if rescuer is trained, add rescue breaths to the chest compressions in a ratio of 30 compressions to 2 breaths. Lay rescuers should continue CPR until an automated external defibrillator (AED) arrives, the victim wakes up, or EMS personnel take over.