Revise recognition, compressions, defibrillation, medicines, investigations and nursing care before, during and after adult resuscitation.
Cardiopulmonary resuscitation (CPR) supplies temporary circulation and oxygen delivery during cardiac arrest. BLS combines recognition, compressions, ventilation and AED use; ALS adds rhythm-directed treatment, vascular access, medicines and airway management.
This page covers adult BLS, including people with signs of puberty. Infants and prepubertal children have a separate page. ROSC means return of spontaneous circulation: the patient has regained effective circulation, but still needs intensive assessment.
AHA 2025: Adult Basic Life Support · AHA 2025: Adult healthcare-professional BLS algorithm
AHA 2025: Adult healthcare-professional BLS algorithm · AHA 2025: Adult Advanced Life Support
CPR is an emergency intervention, not an elective procedure with routine laboratory contraindications. Follow local law, documented care decisions and the responsible clinician’s direction.
AHA 2025: Ethics and decisions about CPR · AHA 2025: Adult Advanced Life Support
AHA 2025: Adult Basic Life Support · AHA 2025: Adult healthcare-professional BLS algorithm
| Component | Adult approach |
|---|---|
| Compressions | 100–120/min; depth at least 5 cm, avoiding excessive depth greater than 6 cm. Lower half of sternum; two hands; full recoil. |
| Ventilation without advanced airway | 30:2. Give each breath over about 1 second, just enough for visible chest rise. Prefer a two-person bag-mask seal when staff allow. |
| Advanced airway | Continuous compressions; 1 breath every 6 seconds. Confirm and monitor tracheal tube position using waveform capnography. |
| Pauses and fatigue | Keep necessary pauses under 10 seconds; switch compressor about every 2 minutes, sooner if tiring. Do not lean between compressions. |
| Monitor and record | Rhythm checks about every 2 minutes; record collapse, CPR, shocks, doses, airway and ROSC times. Low/falling ETCO₂ prompts a CPR-quality review. |
Attach pads while compressions continue. Clear everyone before shock delivery; manage oxygen safely. Resume compressions immediately after a shock, rather than pausing to look for a pulse. Give oxygen during CPR and avoid excessive bagging.
AHA 2025: Adult Basic Life Support · AHA 2025: Adult cardiac arrest algorithm
| VF / pulseless VT: shockable | PEA / asystole: nonshockable |
|---|---|
| Defibrillate promptly, then resume CPR for 2 minutes. Obtain IV access first; use IO if IV is unsuccessful/not feasible. | Continue CPR and give epinephrine as soon as possible. Confirm apparent asystole with equipment/lead checks without a prolonged pause. |
| If VF/pVT persists after the second shock, epinephrine is given during the next CPR cycle; after the third shock, amiodarone or lidocaine is considered. | Do not shock PEA or asystole. Reassess rhythm and treat a new shockable rhythm if it develops. |
Adult shock energy: biphasic manufacturer setting (commonly 120–200 J initially); if unknown, use the maximum available setting. Later shocks are at least equivalent; higher doses may be considered. Monophasic: 360 J.
Search for reversible causes: hypovolaemia, hypoxia, acidosis, hypo-/hyperkalaemia, hypothermia; tension pneumothorax, tamponade, toxins, pulmonary thrombosis and coronary thrombosis. Assign someone to check the history and likely cause while CPR continues.
AHA 2025: Adult Advanced Life Support · AHA 2025: Adult cardiac arrest algorithm
| Medicine | When / adult IV or IO dose | Nursing priority |
|---|---|---|
| Epinephrine (adrenaline) | 1 mg every 3–5 minutes during cardiac arrest. PEA/asystole: as soon as possible; VF/pVT: after initial defibrillation attempts. | Use the locally supplied arrest preparation; document each dose and avoid duplicate administration. |
| Amiodarone | Shock-refractory VF/pVT: 300 mg bolus, then 150 mg if indicated. | Not a treatment for asystole. Continue CPR and rhythm-directed shocks. |
| Lidocaine: alternative | First 1–1.5 mg/kg, then 0.5–0.75 mg/kg if indicated. | Use as the protocol-selected alternative to amiodarone; check cumulative dosing. |
| Cause-specific treatment | Magnesium for torsades when indicated; calcium, bicarbonate, glucose or antidotes only for an appropriate identified/suspected cause and order. | Calcium, bicarbonate and magnesium are not routine drugs for every arrest. Atropine is not routine treatment of PEA/asystole. |
| After ROSC | Titrated fluids, vasopressor/inotrope, analgesia/sedation or antiseizure treatment may be ordered. | Monitor BP, rhythm, perfusion and response. The repeated arrest epinephrine bolus is not a routine post-ROSC prescription. |
AHA 2025: Adult cardiac arrest algorithm · AHA 2025: Adult Advanced Life Support · AHA 2025: Adult and paediatric special circumstances
| Stage | Assessment / test | Why it helps |
|---|---|---|
| Before or at collapse | Review available history, medicines and trends, while immediately assessing responsiveness, breathing and pulse. | Recognise deterioration/arrest; recent potassium results or dialysis history may suggest a cause. |
| During CPR | Monitor/AED rhythm; waveform ETCO₂ after advanced airway; glucose, blood gas and electrolytes when available without delaying care. | Guide shocks, review ventilation/perfusion and identify reversible causes. Blood results are interpreted with the clinical picture. |
| During CPR, selected cases | Skilled point-of-care ultrasound only if it does not prolong interruptions. | May support identification of tamponade or another treatable cause; cannot replace pulse/rhythm assessment or justify extra pauses. |
| After ROSC | 12-lead ECG as soon as feasible; ABG, glucose, potassium/magnesium, lactate and renal function; other blood tests according to cause. | Assess ischaemia, gas exchange, perfusion, metabolic disturbance and organ injury. |
| After ROSC, as indicated | Echo; chest imaging for airway/lung complications; CT or coronary evaluation; EEG for suspected seizures/persistent impaired consciousness. | Investigate the likely cause and complications. No single scan or immediate neurological exam alone determines prognosis. |
AHA 2025: Adult Advanced Life Support · AHA 2025: Adult post-cardiac arrest care
Choose one best answer before opening the explanation. These are original Nursing Medium practice questions, not official AHA examination items.
Correct answer: B. Activate the code and start CPR
Rationale: Gasps do not count as normal breathing. An uncertain pulse must not lead to a prolonged assessment delay.
Correct answer: D. One breath every 6 seconds, reassessing the pulse
Rationale: This is respiratory arrest with a pulse. Provide about 10 breaths/min and watch for loss of circulation.
Correct answer: A. Use 100–120/min and allow full recoil
Rationale: Excessive speed and incomplete release reduce effective compression quality. Correct both technique problems.
Correct answer: C. 30:2
Rationale: The adult ratio remains 30:2 even with two rescuers until an advanced airway allows asynchronous breaths.
Correct answer: D. Deliver a shock promptly, then resume CPR
Rationale: A ready shock should not wait for medication preparation. Immediately restart compressions after delivery.
Correct answer: A. CPR and early epinephrine; investigate causes
Rationale: Organised electrical activity without circulation is PEA, which is nonshockable.
Correct answer: C. 1 mg IV/IO every 3–5 minutes
Rationale: The adult arrest dose is a fixed 1 mg, unlike paediatric weight-based dosing. Record timing to avoid duplication.
Correct answer: B. 300 mg IV/IO bolus
Rationale: For shock-refractory adult VF/pVT, the first bolus is 300 mg; a later dose is 150 mg if indicated.
Correct answer: A. One breath every 6 seconds
Rationale: An advanced airway permits continuous compressions with about 10 breaths/min in adults. Avoid overventilation.
Correct answer: D. Arrange tests in parallel without prolonging pauses
Rationale: Tests can help identify a cause, but should not take priority over circulation and prompt defibrillation.
Correct answer: B. Titrate oxygen toward 90–98%, using reliable measurements
Rationale: Post-arrest care avoids both hypoxaemia and unnecessary hyperoxaemia. Titrate rather than abruptly remove support.
Correct answer: C. Escalate and implement prescribed support toward MAP at least 65 mm Hg
Rationale: Persistent hypotension threatens organ perfusion. Post-ROSC treatment is titrated to haemodynamics, not simply continued arrest boluses.
Checked 22 October 2026 against the 2025 AHA CPR/ECC guidelines; paediatric recommendations are jointly developed with the AAP. These independent Nursing Medium study notes are not an AHA course, endorsement or certification. Practise CPR through hands-on training; clinical teams follow the current local protocol and patient-specific orders.
Nursing Medium