The shockable rhythm is V-Fib, or ventricular fibrillation.Rescuers should switch turns every 5 cycles of compressions to keep compressions strong and avoid fatigue.If there're 2 EMTs, one can perform continuous chest compressions while the other ventilates at the appropriate rate (5-6 bpm for adults and 3-5 bpm for infants and children).Minimize interruptions to chest compressions to less than 10 seconds.If cardiac arrest is witnessed or occurred within 5 minutes, apply AED immediately.For infants, use thumbs to perform compressions (two thumb-encircling hands technique).Ventilation for children should occur at a rate of 1 breath per 3-5 seconds.Compression to ventilation ratio for children should optimally be 15:2, if possible (such as if there are 2 rescuers).You may deliver compressions if heart rate is less than 60 bpm with signs of hypoperfusion.If shock not advised, then immediately resume CPR for 5 cycles and analyze rhythm again.If shockable, clear again and shock, then immediately resume CPR for 5 cycles.Clear: ask people in the immediate surrounding to keep away.Allow for complete chest recoil before pushing again.Push hard and deep so that blood gets pumped (1½ to 2 inches of compression).Arms straight so that you are using the weight of your body to push straight down.Perform compressions by pushing on the chest between the nipples with both hands (the heel of one hand pushes on the patient's chest and the heel of the other hand is placed over the first one).Remove all clothing covering the chest.Make sure the patient is lying on a hard surface.If no pulse, perform 5 cycles of 30:2 compressions:ventilations. Only approach the collapsed person if you believe that it is safe to do so.If there is a pulse, give 1 breath every 5-6 seconds and recheck pulse every 2 minutes.Check the carotid pulse (5-10 seconds).Requires you to hold the mask firmly down to maintain a good seal. Bag-valve mask: you sqeeze on a bag to ventilate through a mask that covers both the mouth and the nose.Mouth-to-mask: you deliver breaths through a mask that covers both the mouth and the nose.Requires you to pinch the patient's nose and give breaths through the mouth. Mouth-to-mouth: the most effective seal formed.Watch for chest rise and avoid gastric inflation. The 2005 Emergency Cardiac Care guidelines for basic life support (BLS) recommend a compression to ventilation ratio of 30:2. If no breathing (or inadequate breathing), give 2 breaths.Feel for air movement through the nose and also for chest rise.In another pig study, there was improved coronary perfusion pressure with a ventilation rate of 10 min 1 compared to 35 min 1 but no difference in 1 h and 24 h survival 22.
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