6 Integrated Cardiovascular Emergency Practice

The shared response sequence

These adult-focused response steps reinforce skills but do not replace hands-on CPR/AED training. Follow your training, local emergency procedures, and dispatcher instructions.

1. Check safety. Look for hazards and use available protective equipment.

2. Assess and call for help. Check responsiveness. If the person is unresponsive, shout for help, activate 911 or emergency response, and ask someone to bring an AED. Check breathing; gasping is not normal breathing. A lay rescuer should not delay CPR to check a pulse. A trained healthcare professional may check breathing and pulse together for no more than $10$ seconds.

3. Act on what you find. For an unresponsive person who is absent or abnormal in breathing, start CPR and use the AED as soon as it arrives. For a responsive person with possible heart attack or stroke symptoms, call 911 promptly and monitor closely.

4. Reassess and hand off. Continue care, watch for changes, and give arriving responders a clear, concise report.

Early CPR and defibrillation are key interventions in cardiac arrest.

Possible heart attack and circulatory shock

Chest pressure or discomfort, shortness of breath, nausea, sweating, and lightheadedness can be signs of a heart attack. When an adult reports chest pressure, nausea, and shortness of breath and looks pale and sweaty or feels faint, check responsiveness and breathing, ensure the scene is safe, and call 911.

Keep the person at rest, in a position that helps them breathe comfortably, and do not leave them alone. Ask when symptoms began and what changed, and note relevant history or medicines if readily available. Do not delay the emergency call to gather details.

Monitor for worsening breathing, confusion, fainting, or unresponsiveness. If the person becomes unresponsive and is not breathing normally, begin CPR and get the AED.

Responding to possible circulatory shock

Circulatory shock is a life-threatening state in which organs do not receive adequate blood flow. Suspect it if someone is deteriorating, confused, faint, or showing signs of poor perfusion. Activate emergency services and monitor the person. If the person is alert, they may be placed supine if tolerated; if they have trouble breathing, allow a comfortable breathing position. Keep them warm and avoid giving food or drink.

CPR for sudden collapse

For an adult who suddenly collapses, is unresponsive, and is not breathing normally, one rescuer calls 911 and gets an AED while another starts CPR. Use speakerphone if alone. If alone, activate emergency response first, then begin CPR.

Place the person on their back on a firm surface. Push hard and fast in the center of the chest at $100\text{–}120$ compressions per minute, to a depth of at least $2$ inches ($5$ cm) for an average adult, and allow full chest recoil. If trained and able, use cycles of $30$ compressions and $2$ breaths. Otherwise, provide continuous chest compressions while help is on the way.

If the compressor tires, switch with another compressor about every $2$ minutes, or sooner if needed, with as little interruption as possible.

AED use and the two meanings of shock

When the AED arrives, turn it on and follow its prompts. Expose and dry the chest if needed, then apply the pads as shown. Make sure nobody is touching the person while the AED analyzes or delivers a shock.

If a shock is advised, clear the person and deliver the shock as directed. Immediately resume CPR afterward. If no shock is advised, immediately resume CPR. Continue following AED prompts until the person shows signs of life, trained responders take over, or you cannot continue.

An AED shock is a controlled electrical treatment the device may recommend during cardiac arrest. It is different from circulatory shock, which is inadequate circulation to vital organs.

Reassessment and handoff

When EMS arrives while CPR and AED care are underway, continue CPR while one team member gives a concise handoff, unless responders direct otherwise. Do not stop CPR merely to give the report; assign a teammate to communicate while care continues.

Include what happened, such as whether the collapse was witnessed and the person’s initial responsiveness and breathing. Give estimated collapse and CPR start times, the time of AED analysis and any shock, what CPR and AED care were performed, and any observed change. Describe current breathing, movement, responsiveness, and new concerns. Add known symptoms before collapse, medical history or medicines if known, and the name of anyone who can provide more information.

Use plain language, distinguish what is known from what is uncertain, and invite questions.

Team coordination

Assign one person to compressions, one to the AED, and one to call 911 and guide responders in. Use names and closed-loop directions: for example, ask a named teammate to call 911 and report back; the receiver confirms the task.

During the response, reassess for changes and keep pauses in CPR brief. A team should apply the AED promptly and ensure everyone stands clear for analysis and any shock.