Skip to content

Cardiac Arrest Management / AED

Category: Procedures Sources: raw/nremt/psychomotor-skills.md, raw/supplemental/patient-assessment-sequence.md Last updated: 2026-04-03

Overview

Cardiac arrest management integrates CPR with automated external defibrillator (AED) use to achieve return of spontaneous circulation (ROSC). Early, high-quality CPR and early defibrillation are the two interventions with the strongest evidence for improving survival. The EMT-B role is to deliver both without interruption and coordinate with team members.

Key Points

  • Assess responsiveness: Tap shoulders, call out. Unresponsive + no breathing (or only agonal gasping) → cardiac arrest.
  • Simultaneously: Check carotid pulse for no more than 10 seconds. If no pulse (or uncertain) → begin CPR immediately.
  • CPR quality standards (adult):
  • Rate: 100–120 compressions per minute
  • Depth: at least 2 inches (5 cm); no more than 2.4 inches
  • Full chest recoil between compressions — do not lean on the chest
  • Minimize interruptions: pause for compressions should be <10 seconds
  • Compression-to-ventilation ratio: 30:2 (no advanced airway); continuous compressions at 100–120/min if advanced airway placed
  • AED use:
  • Power on AED
  • Attach pads (upper right chest below clavicle; lower left ribs / lateral chest)
  • Analyze rhythm — clear the patient, do not touch
  • If shock advised: clear patient, deliver shock
  • Immediately resume CPR after shock — do not check pulse first
  • If no shock advised: resume CPR immediately
  • 2-minute CPR cycles: Standard cycle is 2 minutes of CPR → AED analyze → shock or resume CPR. Repeat.
  • Team integration: Assign roles (compressor, ventilator, AED operator). Rotate compressor every 2 minutes to maintain quality.

Assessment Relevance

Cardiac arrest is identified during primary-assessment: - Unresponsive (AVPU: U) - No breathing or agonal gasps - No pulse (carotid, <10 seconds)

Immediately: call for AED and additional resources, begin CPR. Do not complete a full primary assessment before starting compressions — the assessment IS the diagnosis.

After ROSC: resume full primary-assessment and secondary-assessment — the patient is now a priority transport. Reassess every 5 minutes (critical patient protocol per reassessment).

Procedures

Scene Setup

  1. Confirm scene safety (scene-size-up).
  2. BSI/PPE.
  3. Assess responsiveness — tap, shout.
  4. Call for AED and additional help.

CPR

  1. Position patient supine on firm flat surface.
  2. Check carotid pulse — no more than 10 seconds.
  3. Begin chest compressions: 100–120/min, ≥2 inches depth, full recoil.
  4. After 30 compressions: open airway, deliver 2 breaths via bvm-ventilation (1 second each, watch for chest rise).
  5. Continue 30:2 cycles.

AED Application

  1. Power on AED when it arrives.
  2. Bare the chest; dry if wet.
  3. Apply pads as directed (upper right / lower left — or anterior/posterior for small patients or special situations).
  4. Plug in connector.
  5. Verbalize "analyzing rhythm — everyone clear" and ensure no contact.
  6. Follow AED voice prompts.
  7. If shock advised: "Shocking — everyone clear"; deliver shock; immediately resume CPR.
  8. If no shock advised: immediately resume CPR.

Post-Cycle

  1. Continue 2-minute CPR cycles with AED analysis between cycles.
  2. Rotate compressor every 2 minutes.
  3. Maintain oxygen-administration — BVM with O2 at 15 LPM.
  4. Document: time of arrest (if known), time CPR started, time first shock, number of shocks, medications given, time of ROSC (if achieved).

NM Protocol Notes

  • NM EMT-B protocol follows current AHA guidelines for BLS cardiac arrest management.
  • AEDs are required on all NM BLS units.
  • Special situations in NM protocols — do not defibrillate in a moving vehicle; pull over to analyze and shock.
  • Early ALS intercept request is standard for cardiac arrest in NM; Advanced EMT or Paramedic may administer epinephrine and perform advanced airway.
  • Hypothermic arrest: continue CPR and AED; do not assume death until the patient is "warm and dead."
  • Traumatic cardiac arrest: focus on reversible causes (tension pneumothorax, hemorrhage); standard BLS CPR with AED still applied.

NREMT Relevance

Cardiac arrest management / AED is a standalone NREMT psychomotor skill station. Examiners assess: - Promptly recognizing cardiac arrest - Beginning CPR without delay - Correct compression rate and depth - Correct 30:2 ratio - AED application without significant interruption to CPR - Clearing the patient before analyze and before shock - Resuming CPR immediately after shock (do not pause to check pulse) - Team integration / role assignment

Critical failures: delayed CPR start, inadequate compression depth, failing to clear before shock, long pauses for pulse check, AED pads applied incorrectly.

Sources

  • raw/nremt/psychomotor-skills.md — Cardiac Arrest Management / AED
  • raw/supplemental/patient-assessment-sequence.md — Primary Assessment (LOC, Breathing, Circulation sections)