THE UPDATED AHA ADULT CHAINS OF SURVIVAL
Out-of-hospital Cardiac Airest
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ln-hospttal Cardiac ArTest
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Verify scene safety.
• Check for responsiveness.
• Shout for nearby help.
• Ac tivate emergency response
system via mobile device
{if appropriate).
• Get AED and emergency equipment
{or send someone to do so).
Normal No normal • Provide rescue breathing.
brea th i ng, breathing, 1 breath every 6 seconds or
look for no breathing
Monitor until p ulse felt or only gasping and check
pulse felt 10 breaths/min.
emergency '-------'►' • Check pulse every 2 minutes;
pulse {simultaneously).
if no pulse, start CPR.
responders arrive. Is pulse definitely felt
• If possible opioid overdose.
within 10 seconds? administer naloxone If
available per protocol.
No breathing
or only gasping,
pulse not felt
By this time in all scenarios. emergency
response system or backup is activated,
and AED and emergency equipment are
retrieved or someone is retrieving them.
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Start CPR
• Perform cycles of 30 compressions
and 2 breaths.
• Use AED as soon as it is available.
AED arrives.
Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockabl e
• Give 1 shock. Resume CPR
Immediately for 2 minutes
-. Resume CPR Immediately ~
2 minutes {until prompted by AED
-
(until prompted IJy AED to allow to allow rhyt11m check).
rltythm check).
• Continue until ALS provi ders take
over or victim starts to move.
r\.
• Continue untll ALS providers take
over or victim star ts to move.
C 2020 American Heart Association
(1)
I Verify scene safety.
(2)
\_ . .
t
• Check for responsiveness .
• Shout for nearby help.
• Activate the emergency response system
via mobile device (if appropriate).
{lb)
Normal
breathing,
(
Hook
! -
31
for no breathing
No normal
~ ..,, • Provide rescue breathing,
1 breath every 2-3 seconds.
breathing, or about 20-30 breaths/min.
Monitor until pulse felt/ / or only gasping and check pulse felt ' • Assess pulse rate for no
emergency pulse (simultaneously). more than 10 seconds.
responders arrive. Is pulse deflnltely felt
within 10 seconds?
4 f----'---,
Yes HR <60/min No
with signs of poor
perfusion?
No breathing @
or only gasping,
pulse not felt
(4;)Start ~;,;: ) I • Continue rescue
breathing; check
pu lse every
2 minutes.
• If no pulse, start
CPR.
'·~ - - - - - -
~ )----..... @ --
Yes Activate emergency response
Witnessed " ";,--- - - - ~ system (if not already done).
"'--, sudden col lapse?
'- \_ an~~ r_e~ri~~e AED/defibrillator.
No
(s) - - - --'---------
StartCPR
• 1 rescuer: Perform cycles of
30 compressions and 2 breaths. l◄l(ll------------'
• When second rescuer arrives,
perform cycles of 15 compressions
and 2 breaths.
• Use AED as soon as it is available.
0 After about 2 minutes, if still alone, activate
emergency respon se system and re trieve AED
(if not already done).
Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable
• Give 1 shock. Resume CPR • Resume CPR immediately for
immed ia tely for 2 minutes 2 minutes (until prompted by AED
(until prompted by AED to allow to allow rhythm check).
rhyth m check). • Continue until ALS providers take
• Continue until ALS providers lake over or the child starts to move.
\.. ____________ _
over or the child starts to move.
© 2020 American Heart Ass oc i,Jt ion
0 Suspecte d opioid poisoning
• Check for responsiveness.
• Shout for nearby help.
• Activate the emergen cy response system.
• Get naloxone and an AED if available.
Yes ls the No
person breathing
normally?
~ 3 > - - - - - - - - - - " - - - - - -,,
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Prevent deteriora tion Doesthe
• Tap and shout. Yes person have a pulse?
• Open the airway and reposition . (Assess for ~10
• Consider naloxone. seconds.)
• Transpor t to the hospital.
)
0
- ~ -.0 - --- - · -···- -
~--, -_- j~ - , Support ventilation
; 7
Start CPR
Ongoing assessm ent of
responsi veness and breathing • Open the airway and • Use an AED.
Go to 1. reposition. • Consider naloxone.
• Provide rescue breathing or • Refer to the BLS/Cardiac
a bag-mask device. Arrest algorithm .
• Give naloxone.
© 2020 American Heart Association
Verity scene safety.
• Check for responsiveness.
• Shout for nearby help.
• Activate emergency response system via
mobile device (if appropriate).
- Alert them about maternal cardiac arrest.
• Get AED and emergency equipment (or send
someone to do so).
Normal No normal • Provide rescue breathing,
breathing, breathing, 1 breath every 6 seconds or
, • Roll/wedge victim Look for no breathing
pulse felt 10 breaths/min.
onto left side. pulse felt / or only gasping and check • Check pulse every 2 minutes;
• Monitor until pulse (simultaneously). if no pulse, start CPR.
emergency Is pulse definitely felt • If possible opioid overdose.
responders arrive . within 10 seconds? administer naloxone if
available per protocol. ;
\ ./
No breathing
or only gasping,
pulse not felt
By this time in all scenarios, emergency
response system or backup is activated,
and AED and emergency equipment are
retrieved or someone is retrieving them.
Start CPR
• Perform cyc les of 30 co mpressions
and 2 breaths. Maternal Cardiac Arrest
1
• Use AED as soon as it is available.
\. Priorities for pregnant women in
7 cardiac arrest include
• Continuation of high-quality
CPR with attention to good
If uterus Is at or above the
ventilation
umbilicus and additional rescuers
• Lateral uterine displacement
are present, perform continuous to relieve pressure on major
lateral uterine displacement.__., vessels in the abdomen to
help with blood flow
• Rapid initiation of emergency
medical services to direct
AED arrives.
care and early transport to the
appropriate facility
Check rhythm.
Shockable rhyt hm?
Ye s, No,
shockable nonshockable
(
• Give 1 shock. Resume CPR
immediately for 2 minutes
• Resume CPR immediately for
2 minutes (unt il prompted by AED
I
(until prompted by AED to allow to allow rhythm check).
rhy thm check). • Continue until ALS providers take
• Continue until ALS providers take over or victim start s to move.
over or victim starts to move.
© 2020 American Heart Associ at ion