Key Takeaways
- BLS/CPR: Push hard (2-2.4 inches in adults) and fast (100-120 compressions/min), allow full chest recoil, minimize interruptions
- Adult compression-to-ventilation ratio: 30:2 (one or two rescuers without advanced airway); continuous compressions with advanced airway (1 breath every 6 seconds)
- AED: Apply pads, analyze rhythm, shock if indicated (VF/pulseless VT); resume CPR immediately after shock
- ACLS: Epinephrine 1 mg IV/IO every 3-5 minutes for all cardiac arrest rhythms; amiodarone 300 mg IV for refractory VF/pulseless VT
- Shockable rhythms: ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT); non-shockable: PEA and asystole
- Rapid Response Teams (RRTs) are activated for patients with acute deterioration before full cardiac arrest occurs
- Neonatal resuscitation (NRP): Warm-dry-stimulate, clear airway if needed, PPV at 40-60 breaths/min, chest compressions if HR <60 despite 30 seconds of effective PPV
- Emergency airway: Cricothyrotomy is the surgical rescue airway when intubation and supraglottic devices fail (cannot intubate, cannot oxygenate)
Emergency Procedures & Resuscitation
Respiratory therapists are key members of resuscitation teams, responsible for airway management, ventilation, and often medication administration during emergencies. The TMC exam tests your knowledge of BLS, ACLS, and neonatal resuscitation protocols, as well as your understanding of emergency airway management.
Basic Life Support (BLS) — Adult CPR
| Parameter | Guidelines (AHA 2020+) |
|---|---|
| Compression depth | 2 to 2.4 inches (5-6 cm) in adults |
| Compression rate | 100-120 compressions per minute |
| Chest recoil | Allow full recoil between compressions; do not lean on the chest |
| Compression-to-ventilation ratio | 30:2 (without advanced airway) |
| With advanced airway | Continuous compressions; 1 breath every 6 seconds (10 breaths/min) |
| Compression fraction | Aim for >80% (minimize interruptions) |
| Ventilation volume | Enough to produce visible chest rise (avoid excessive ventilation) |
| Switch compressors | Every 2 minutes (or 5 cycles of 30:2) |
AED (Automated External Defibrillator)
Shockable Rhythms:
- Ventricular fibrillation (VF): Chaotic, disorganized electrical activity; no effective pumping
- Pulseless ventricular tachycardia (pVT): Rapid, regular wide-complex rhythm; no pulse
Non-Shockable Rhythms:
- Pulseless Electrical Activity (PEA): Organized electrical activity on monitor but no pulse
- Asystole: Flat line; no electrical activity
AED Protocol:
- Turn on the AED
- Apply pads to the chest (right upper sternal border and left lateral chest)
- Clear the patient; allow the AED to analyze
- If shock advised, clear and deliver shock
- Resume CPR immediately after shock — do NOT check pulse until 2 minutes of CPR completed
ACLS Cardiac Arrest Algorithm
Medications:
| Drug | Dose | Route | Indication | Frequency |
|---|---|---|---|---|
| Epinephrine | 1 mg | IV/IO | ALL cardiac arrest rhythms | Every 3-5 minutes |
| Amiodarone | 300 mg (1st), 150 mg (2nd) | IV/IO | Refractory VF/pulseless VT | After 3rd shock |
| Lidocaine | 1-1.5 mg/kg (1st), 0.5-0.75 mg/kg (subsequent) | IV/IO | Alternative to amiodarone for VF/pVT | Every 5-10 minutes |
| Atropine | 1 mg | IV | Symptomatic bradycardia (NOT for cardiac arrest) | Every 3-5 min (max 3 mg) |
Reversible Causes (H's and T's):
| H's | T's |
|---|---|
| Hypovolemia | Tension pneumothorax |
| Hypoxia | Tamponade (cardiac) |
| Hydrogen ion (acidosis) | Toxins (drug overdose) |
| Hypo/hyperkalemia | Thrombosis (pulmonary — PE) |
| Hypothermia | Thrombosis (coronary — MI) |
Rapid Response Teams (RRT)
Rapid Response Teams are activated before cardiac arrest occurs, when a patient shows signs of clinical deterioration:
Common RRT Activation Criteria:
- Heart rate <40 or >130 beats/min
- Systolic BP <90 mmHg
- Respiratory rate <8 or >28 breaths/min
- SpO2 <90% despite oxygen therapy
- Acute change in mental status
- Staff member has a sense of concern about the patient
- Urine output <50 mL over 4 hours
Neonatal Resuscitation (NRP)
| Step | Action | Assessment |
|---|---|---|
| 1. Initial steps | Warm, dry, stimulate, clear airway (if needed), position | Term? Tone? Breathing/crying? |
| 2. Positive pressure ventilation (PPV) | If HR <100 or apneic/gasping after initial steps | BVM at 40-60 breaths/min; room air or 21-30% O2 initially |
| 3. Chest compressions | If HR <60 despite 30 seconds of effective PPV | 3:1 ratio (3 compressions: 1 breath); 120 events/min |
| 4. Epinephrine | If HR <60 despite effective compressions + PPV | 0.01-0.03 mg/kg IV/IO (or 0.05-0.1 mg/kg ET) |
Emergency Surgical Airway
Cricothyrotomy is the last-resort airway when:
- Cannot intubate (failed multiple attempts, supraglottic device failed)
- Cannot oxygenate (SpO2 falling, patient deteriorating)
- Performed through the cricothyroid membrane (between thyroid and cricoid cartilages)
- Provides immediate access to the trachea
- Temporary measure until a formal tracheostomy can be performed
During an adult cardiac arrest, the CORRECT chest compression rate and depth are:
Which cardiac arrest rhythm is NOT shockable with a defibrillator?
During ACLS, a patient remains in ventricular fibrillation after 3 defibrillation attempts and epinephrine. The NEXT medication to administer is:
In neonatal resuscitation, chest compressions should be initiated when:
Place the neonatal resuscitation (NRP) steps in the correct order.
Arrange the items in the correct order
During adult cardiac arrest with an advanced airway in place, deliver 1 breath every _____ seconds while continuous chest compressions are performed.
Type your answer below
Epinephrine during cardiac arrest is given at what dose and frequency?
Match each cardiac arrest rhythm to its classification.
Match each item on the left with the correct item on the right
Which of the following would be a reason to activate the Rapid Response Team?