Primary Health Care Services
Date of last review 2009
Community Health Centre Clinical Practice Guidelines for Primary Care Nurses
Client who presents with or develops cardiac arrest.
To provide rapid assessment and interventions for clients presenting with cardiac
Absent or inadequate contraction of the left ventricle of the heart that immediately
causes body- wide circulatory failure
Cardiac arrest (or sudden cardiac arrest, sudden cardiac death) is a medical emergency.
Cardiac arrest may have a variety of causes – heart disease, drowning, stroke,
electrocution, suffocation, drug overdose, motor vehicle or other injury. The most
common causes of cardiac arrest are electrical problems in the heart with ventricular
fibrillation representing the major type. In ventricular fibrillation, there is loss of
coordinated ventricular contractions leading to immediate loss of effective output of
blood by the heart, resulting in circulatory arrest. A medical emergency with absent or
inadequate contraction of the left ventricle of the heart that immediately causes body
wide circulatory failure.
5. Signs and Symptoms:
The signs and symptoms can include
loss of consciousness
rapid shallow breathing progressing to apnea (absence of breathing);
profoundly low blood pressure (hypotension) with no pulses that can be felt over major
absence of heart sounds.
Check for Medical Alert bracelet or medal.
Check for unresponsiveness and activate the emergency response system.
Have someone Dial 9-911 immediately, request an ambulance and notify the on-site
Initiate BLS interventions:
Airway Place an oropharyngeal airway, clear obstructions and suction as required.
Breathing Ventilate using pocket mask or bag valve mask and oxygen.
Circulation Once pulselessness established, start chest compressions.
o Attach AED and follow instructions or defibrillator and follow policies specific to
If pulse is present:
Start an IV of NaCl TKVO
Care of the patient is to be immediately transferred to the EMS upon their arrival.
At no time should transport of the patient be delayed for treatment. Treatment will continue
en route as per EMS protocols.
Following departure of patient, contact the Emergency Department to advise that the patient is being
transported and provide a report to the receiving nurse.
8. Referral to Physician:
For any patient with cardiac arrest notify the on-site physician if any and/or call 9-911
Will be done by receiving hospital.
FRAMEWORK FOR DECISION-MAKING
Adult BLS Algorithm
Pediatric BLS Algorithm
Healthcare provider summary of steps of CPR for adults, children and infants
Adults and older
CPR (1 year old to (less than 1 year
Establish that the
victim does not
respond Activate your emergency response
response system as
Activate your system after giving 5 cycles of CPR
soon as the victim
Open the airway
Use head tilt‐chin Head tilt‐chin lift (suspected trauma: jaw trust)
If the victim is not
Open the airway, look, listen and feel
breathing, give 2
Take at least 5 seconds and no more than 10 seconds
breaths that make
the chest rise
Give 2 breaths
First 2 breaths
(1 second each)
Carotid pulse (if no
Check pulse no pulse or pulse
Carotid pulse pulse or pulse is<
At least 5 seconds is< 60 bpm with
(if no pulse, start 60 bpm with signs
and no more than signs of poor
CPR) of poor perfusion,
10 seconds perfusion, start
Compressio Just below nipple
Center of breastbone between nipples
n location line on breastbone
Compressio Heel of 1 hand, other hand on top(or 1 (2 thumb‐
n method hand for small victims) encircling hands
for 2‐rescuer CPR)
1½ to 2 inches to ½ depth of chest
n rate 100 per minute
n‐ 30:2 for 1 rescuer CPR
(1 or 2 rescuer
ventilation (15:2 for 2 rescuer CPR)
NURSES PRACTICE GUIDELINES
Cardiac arrest at________ Respiratory arrest at _______
911 called at __________ On-site physician notified
Airway oropharyngeal size ________
Ventilation with oxygen started at _____ Pocket mask Bag valve mask
Chest compressions started at___________stopped at__________________
AED or defibrillator analyzed at_____ _____ _____ _____ _____ _____ ____
AED or defibrillator shocked at _____ _____ _____ _____ _____ _____ ____
IV NaCL started at_____ size ________ site_______
Vitals signs __________ __________ __________ __________ __________ __________
__________ __________ __________ __________ __________
Medications given _______________________________________________
Prepare patient for transfer
Complete transfer sheet
Phone report to the receiving hospital at _____
Nurse signature: _______________________ Date: ____________
Hearth and stroke, BLS for Healthcare Providers 2005.
Retrieved May 31, 2008 from
Heart and stroke foundation, warning signs 2008. Retrieved May 31, 2008 from
Province of New Brunswick, Provincial Medical Protocol, Adult Protocol: Cardiac arrest overview,
Policy and Procedure Manual, Last updated September 20, 2007
WebMD eMedecine Health, definition of cardiac arrest 2008. Retrieved May 31, 2008 from