European Resuscitation Council Guidelines for Resuscitation 2010 ...

1310 C.D. Deakin et al. / Resuscitation 81 (2010) 1305–1352
Immediate actions for a collapsed patient in a hospital
An algorithm for the initial management of in-hospital cardiac
arrest is shown in Fig. 4.1.
• Ensure personal safety.
• Check the victim for a response.
• When healthcare professionals see a patient collapse or find a
patient apparently unconscious in a clinical area, they should first
shout for help, then assess if the patient is responsive. Gently
shake the shoulders and ask loudly: ‘Are you all right?’
• If other members of staff are nearby, it will be possible to undertake
actions simultaneously.
The responsive patient
Urgent medical assessment is required. Depending on the local
protocols, this may take the form of a resuscitation team (e.g., MET,
RRT). While awaiting this team, give the patient oxygen, attach
monitoring and insert an intravenous cannula.
The unresponsive patient
The exact sequence will depend on the training of staff and
experience in assessment of breathing and circulation. Trained
healthcare staff cannot assess the breathing and pulse sufficiently
reliably to confirm cardiac arrest. 226–235 Agonal breathing (occasional
gasps, slow, laboured or noisy breathing) is common in the
early stages of cardiac arrest and is a sign of cardiac arrest and
should not be confused as a sign of life/circulation. 236–239 Agonal
breathing can also occur during chest compressions as cerebral perfusion
improves, but is not indicative of a return of spontaneous
circulation.
• Shout for help (if not already)
Turn the victim on to his back and then open the airway:
• Open Airway and check breathing:
◦ Open the airway using a head tilt chin lift.
◦ Look in the mouth. If a foreign body or debris is visible attempt
to remove with a finger sweep, forceps or suction as appropriate.
◦ If you suspect that there may have been an injury to the neck,
try to open the airway using a jaw thrust. Remember that maintaining
an airway and adequate ventilation is the overriding
priority in managing a patient with a suspected spinal injury. If
this is unsuccessful, use just enough head tilt to clear the airway.
Use manual in-line stabilisation to minimise head movement if
sufficient rescuers are available. Efforts to protect the cervical
spine must not jeopardise oxygenation and ventilation.
Keeping the airway open, look, listen, and feel for normal breathing
(an occasional gasp, slow, laboured or noisy breathing is not
normal):
• Look for chest movement;
• Listen at the victim’s mouth for breath sounds;
• Feel for air on your cheek.
Look, listen, and feel for no more than 10 s to determine if the
victim is breathing normally
• Check for signs of a circulation:
◦ It may be difficult to be certain that there is no pulse. If the
patient has no signs of life (consciousness, purposeful movement,
normal breathing, or coughing), start CPR until more
experience help arrives or the patient shows signs of life.
Fig. 4.1. Algorithm for the treatment of in-hospital cardiac arrest. © 2010 ERC.