Your assessment of the patient begins with:

Evaluating level of consciousness, presence of normal breathing, and the presence or absence of a pulse.

Assessing airway and breathing.

The presence or absence of a pulse.

Assessing patient level of consciousness.

You determine that he is breathing agonal, about two times per minute. You are unsure if you feel a pulse or not. Your next step is to

Immediately begin chest compressions.

Administer two breaths; making sure that the chest rises with each breath.

Double-check the pulse, taking more time this attempt.

Go to the hallway to direct the cardiac arrest team into the waiting room.

Compressions should be done:

100–120 times per minute to a depth of between 2” and 2.4” (5–6cm).

At least 150 times per minute to a depth of 4

No more than 100 times per minute to a depth of ½ the width of the chest wall.

By pushing as fast and as hard as you can.

You perform 30 compressions being sure that the chest has complete recoil between each compression. Your next step is to:

Provide two breaths; ensuring chest rise with each breath.

Provide one breath; ensuring chest rise.

Continue compressions until the arrest team arrives.

Provide four breaths; ensuring chest rise with each breath.

The x-ray technician arrives with the monitor/defibrillator and attaches it. The monitor reveals ventricular fibrillation. You should:

Immediately defibrillate the patient using the energy level recommended by the defibrillator manufacturer.

Continue chest compressions for at least 2 more minutes prior to defibrillation.

Leave it attached until the arrest team arrives to defibrillate.

In-hospital ventricular fibrillation

You are working in the radiology department as a registered nurse. A panicked secretary calls you to the waiting room where you arrive to find a middle-aged man lying supine on the floor. He appears cyanotic. His wife tells you that they were talking and he suddenly got a funny look on his face and collapsed. He is a diabetic but has no other medical conditions. He was here to have a painful ankle imaged. You instruct the secretary to call for the cardiac arrest team and to send the x-ray technician to retrieve the department defibrillator.

about 3–5 minutes

In-hospital ventricular fibrillation

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