The majority of people who collapse from a cardiac arrest in the community are in VF and are those most likely to survive (AHA & ILCOR 2000). Whatever the setting, hospital, community or home, successful resuscitation depends on early defibrillation (White et al. 1996). The chance of successful defibrillation declines with each minute that VF persists. While effective basic life support (BLS) slows the irreversible damage, it cannot stop it. The patient's rhythm needs to be assessed as soon as possible, preferably with monitoring electrodes from an automatic or manual defibrillator. A dedicated electrocardiogram (ECG) monitor may also be used (see Chapter 8). The first shock should be delivered as soon as possible if the rhythm is VF/VT. (For further information about this arrhythmia see Chapter 8.) If a monitor is not readily available, BLS should be continued until a defibrillator arrives.
The discussion that follows provides a step-by-step account of the ALS algorithm (see Figure 6.1) and the activities that must be performed for patients in either VF/VT or PEA cardiac arrest, once cardiac arrest is confirmed (Resuscitation Council UK 2000a).
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