Monitored and Unmonitored Areas

If nursing and medical acumen and surveillance are in order then most cardiac arrests originating within the ED will occur in monitored areas, typically the resuscitation room. In such circumstances, after confirming cardiac arrest and shouting for help, if the initial rhythm is VF/VT up to three quick successive (stacked) shocks can be given. Start chest compressions immediately after the third shock and continue CPR for 2 minutes. With respect to the ALS algorithm, these three quick, successive shocks are regarded as the first shock.

Rarely, cardiac arrest may occur in unmonitored areas of the department. In such cases the beginning of the algorithm is applicable. Move the patient into the resuscitation room, if practical, calling for assistance at the same time.

The resuscitation room allows more room for the assembling team and provides all the equipment likely to be needed, notably the defibrillator.

The ECG shows grossly widened (sinusoidal) QRST complexes reflecting severe hyperkalaemia.