A 60-year-old man is found to be unresponsive, pulseless, and apneic. You should:
Select one:
- A. begin CPR until an AED is available.
- B. determine if he has a valid living will.
- C. withhold CPR until he is defibrillated.
- D. start CPR and transport immediately.
The correct answer and explanation is:
Correct Answer: A. Begin CPR until an AED is available.
Explanation:
When encountering an unresponsive, pulseless, and apneic patient, the immediate priority is to initiate Cardiopulmonary Resuscitation (CPR). The American Heart Association (AHA) guidelines emphasize the “Chain of Survival”, which includes early recognition, immediate CPR, rapid defibrillation, effective advanced life support, and post-cardiac arrest care.
Why CPR First?
- Oxygenation and Circulation: CPR helps circulate oxygenated blood to vital organs, primarily the brain and heart, preventing irreversible damage.
- Higher Survival Rates: Immediate CPR increases survival rates by maintaining minimal circulation until defibrillation can be performed.
- AED Readiness: While CPR is in progress, an Automated External Defibrillator (AED) should be retrieved and used as soon as it is available.
Why Not the Other Options?
- B. Determine if he has a valid living will:
A living will or Do Not Resuscitate (DNR) order is relevant only if readily available. However, unless there is clear documentation, resuscitative efforts should be started. - C. Withhold CPR until he is defibrillated:
Defibrillation is most effective when performed promptly, but CPR should not be delayed while waiting for an AED. - D. Start CPR and transport immediately:
High-quality CPR should be performed on-site before moving the patient. CPR during transport is often ineffective compared to controlled, uninterrupted CPR.
Conclusion:
The best immediate response is to begin high-quality CPR and use an AED as soon as it becomes available. Early defibrillation, in combination with CPR, provides the best chance of survival for a patient in cardiac arrest.
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