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CARDIOPULMONARY RESUSCITATION
Warning: adequate oxygenation is achieved by the above measures. Endotracheal intubation should only be attempted by those who are trained, competent and experienced.Basic life support: external cardiac massage with assisted ventilationContinue with chest compressions and rescue breaths in a ratio of 30:2. Change the person providing chest compressions every 2 min, but ensure minimum interruption to compressions during the changeover.
Defibrillation
As soon as the defibrillator arrives, apply self-adhesive pads or paddles to the patient whilst continuing chest compressions rapidly shave excessive male chest hair, without delay place one self-adhesive defibrillation pad or conventional paddle to the right of the sternum below the clavicle, and the other adhesive pad or paddle in the mid-axillary line level with the V6 electrocardiogram (ECG) electrode or female breast avoid positioning self-adhesive pads or paddles over an ECG electrode, medication patch, or implanted device, e.g. pacemaker or automatic cardioverter defibrillator. Analyse the rhythm with a brief pause, and charge the defibrillator if the rhythm is VF or pulseless VT. Continue chest compressions until fully charged. Quickly ensure that all rescuers are clear, then give the patient an immediate 150–200 J direct current (DC) shock using a biphasic waveform defibrillator (all modern defibrillators are now biphasic) minimize the delay in delivering the shock, which should take less than 5 s ensure good electrical contact is made when applying manual paddles by using gel pads or electrode jelly, and apply firm pressure of 8 kg force in adults give a 360 J shock if an older monophasic defibrillator is used. Immediately resume chest compressions without reassessing the rhythm or feeling for a pulse. The only exception is when VF is witnessed in a patient already connected to a manual defibrillator, or during cardiac catheterization, and/or early post-cardiac surgery use a stacked, three-shock strategy rapidly delivering three shocks in a row before starting chest compressions. Continue external chest compressions and assisted ventilation for 2 min, then pause briefly to assess the rhythm again.