A1 – Adult Patient Care A2 – Chest Pain / Suspected ACS A3 – Cardiac Arrest – Initial Care and CPR A4 – Ventricular Fibrillation / Ventricular Tachycardia A5 – PEA / Asystole A6 – Symptomatic Bradycardia A7 – Ventricular Tachycardia with Pulses A8 – Supraventricular Tachycardia A9 – Other Dysrhythmias A10 – Shock A11 – Post-Cardiac Arrest Care A12 – Public Safety Defibrillation

ADULT TREATMENT GUIDELINES

A1 ADULT ADULT PATIENT CARE

These basic concepts should be addressed for all adult patients (age 15 and over) Scene Safety Body Substance Isolation

Use universal blood and body fluid precautions at all times

Systematic Assessment

• Assure open and adequate airway. Management of ABC’s is a priority. • Place patient in position of comfort unless condition mandates other position (e.g.

shock, coma) • Consider spinal immobilization if history or possibility of traumatic injury exists

Determine Primary Impression

• Apply appropriate field treatment guideline(s) • Explain procedures to patient and family as appropriate

Base Contact • Contact base hospital if any questions arise concerning treatment or if additional

medication beyond dosages listed in treatment guidelines are considered • Use SBAR to communicate with base

Transport • Minimize scene time in critical trauma, STEMI, stroke, shock, and respiratory failure • Transport patient medications or current list of patient medications to the hospital • Give report to receiving facility using SBAR

Document Document patient assessment and care per policy

A2 ADULT

CHEST PAIN SUSPECTED ACUTE CORONARY SYNDROME

OXYGEN Low flow

PRECAUTION Caution: Do not administer or allow patient to take Nitroglycerin if patient has taken erectile dysfunction meds Viagra or Levitra within 24 hrs or Cialis within 36 hrs. In these situations, severe hypotension may occur as a result of NTG administration.

Nitroglycerin BLS Personnel: Allow patient to take own if BP greater than 90 CARDIAC MONITOR

12 – LEAD ECG If transmission available, transmit ECG. If STEMI detected, alert STEMI Center. Perform right-sided lead (V4R) if inferior MI noted. Repeat ECGs are encouraged.

ASPIRIN 325 mg po to be chewed by patient – DO NOT administer if patient has allergies to aspirin or salicylates or has apparent active gastrointestinal bleeding

IV TKO

NITROGLYCERIN 0.4 mg sl if systolic BP above 90. May repeat every 5 minutes until pain subsides, maximum 6 doses or BP less than 90 systolic.

Do not administer Nitroglycerin if Right Ventricular MI suspected

Consider MORPHINE SULFATE

2-20 mg IV in 2-4 mg increments for pain relief if BP greater than 90 and NTG not effective. Consider earlier administration to patients in severe distress from pain.

Titrate to pain relief, systolic BP greater than 90, and adequate respiratory effort. If persistent pain, continue NITROGLYCERIN to maximum of 6 doses.

Do not administer Morphine Sulfate if Right Ventricular MI suspected Consider FLUID BOLUS

250 ml NS if BP less than 90, lungs clear and unresponsive to positioning. May repeat X 1. Patients with Right Ventricular MI may require multiple fluid boluses.

Key Treatment Considerations • Classic symptoms: Substernal pain, discomfort or tightness with radiation to jaw, left shoulder

or arm, nausea, diaphoresis, dyspnea (shortness of breath), anxiety • Diabetic, female or elderly patients frequently present atypically • Atypical symptoms can include syncope, weakness or sudden onset fatigue • Rapid identification of STEMI to speed intervention is the goal of 12-lead ECG • 12-lead ECG should be acquired as soon as possible after arrival (ideally within 5 minutes) • 12-lead ECG should be acquired before initial NTG administration • 12-lead ECG should be acquired prior to treatments for bradycardia if condition permits • Minimize scene time in STEMI patients • If STEMI noted and ST elevation is noted in inferior distribution (leads II, III, and aVF), the possibility for

right ventricular MI (RVMI) exists o Perform ECG with right-sided lead (V4R) mirrored in the same orientation as V4. RVMI should be

suspected if ST elevation of 1 mm or greater in V4R. o Patients with RVMI may present with shock or poor perfusion in the presence of clear lungs and

may have jugular venous distention. o Nitroglycerin and Morphine should not be administered in the setting of RVMI. Trendelenburg

positioning and fluid bolus is appropriate treatment for shock in this setting. • If STEMI noted and ST elevation is noted in anterior distribution (V1-V4), patient is at higher risk for

pump failure and CHF on presentation • Many STEMI’s evolve during prehospital period and are not noted during first ECG, so repeat 12-lead

ECGs are encouraged (avoid artifact by patient or vehicle movement) • IV placement prior to NTG recommended in patients who have not taken NTG previously

A3 ADULT CARDIAC ARREST – INITIAL CARE AND CPR

ESTABLISH TEAM LEADER

• First agency on scene assumes leadership role • Leadership role can be transferred as additional personnel arrive

CONFIRM ARREST • Unresponsive, no breathing or agonal respirations, no pulse

COMPRESSIONS

Begin Compressions: • Rate – at least 100/minute • Depth - 2 inches in adults – allow full recoil of chest (lift heel of hand) • Rotate compressors every 2 minutes if manual compression used Minimize interruptions. If necessary to interrupt, limit to 10 seconds or less. • Perform CPR during charging of defibrillator • Resume CPR immediately after shock (do not stop for pulse or rhythm check) Prepare mechanical compression device (if available). • Apply with minimal interruption • Should be placed following completion of at least one 2-minute manual CPR

cycle or at end of subsequent cycle

AED or MONITOR/ DEFIBRILLATOR

• Apply pads while compressions in progress • Determine rhythm and shock, if indicated • Follow specific treatment guideline based on rhythm

BASIC AIRWAY MANAGEMENT and VENTILATION

• Open airway and provide 2 breaths after every 30 compressions • Avoid excessive ventilation – no more than 8 – 10 ventilations per minute • Ventilations should be about 1 second each, enough to cause visible chest rise • Use two-person BLS Airway management (one holding mask and one

squeezing bag) • If available, use ResQPOD with two-person BLS airway management

IV / IO ACCESS • IO access is preferred unless no suitable site is available • If IV used (no IO access), antecubital vein is preferred. • Hand veins and other smaller veins should not be used in cardiac arrest

ADVANCED AIRWAY

• Placement of advanced airway is not a priority during the first 5 minutes of resuscitation unless no ventilation is occurring with basic maneuvers. o Exception: If ResQPOD used, early use of King Airway is appropriate

• Placement of King Airway or endotracheal tube should not interrupt compressions for more than 10 seconds

• For endotracheal intubation, position and visualize airway prior to cessation of CPR for tube passage. Immediately resume compressions after tube passage.

• Confirm tube placement and provide on-going monitoring using end-tidal carbon dioxide monitoring

TREATMENT ON SCENE

• Movement of a patient may interrupt CPR or prevent adequate depth and rate of compressions, which may be detrimental to patient outcome

• Provide resuscitative efforts on scene up to 30 minutes to maximize chances of return of spontaneous circulation (ROSC)

• If resuscitation does not attain ROSC, consider cessation of efforts per policy

A4 ADULT

VENTRICULAR FIBRILLATION PULSELESS VENTRICULAR TACHYCARDIA

INITIAL CARE See Cardiac Arrest – Initial Care and CPR (A3) DEFIBRILLATION 200 joules (low energy 120 joules) CPR For 2 minutes or 5 cycles between rhythm check

VENTILATION/AIRWAY • BLS airway is preferred method during first 5 -6 minutes of CPR • If no ventilation occurring with basic maneuvers, proceed to advanced airway

IO or IV TKO. Should not delay shock or interrupt CPR DEFIBRILLATION 300 joules (low energy 150 joules) EPINEPHRINE 1:10,000 - 1 mg IV or IO every 3-5 minutes DEFIBRILLATION 360 joules (low energy 200 joules) AMIODARONE 300 mg IV or IO DEFIBRILLATION 360 joules (low energy 200 joules) as indicated after every CPR cycle

ADVANCED AIRWAY • Should not interfere with initial 5-6 minutes of CPR – minimize interruptions • Do not interrupt compressions more than 10 seconds to obtain airway

Consider repeat AMIODARONE If rhythm persists, 150 mg IV or IO, 3-5 minutes after initial dose

TRANSPORT If indicated Consider SODIUM BICARBONATE 1 mEq/kg IV or IO for suspected hyperkalemia or pre-existing acidosis

If Return of Spontaneous Circulation, see Post-Cardiac Arrest Care (A11)

Key Treatment Considerations • Uninterrupted CPR and timely defibrillations are the keys to successful resuscitation. Their performance

takes precedence over advanced airway management and administration of medications. • To minimize CPR interruptions, perform CPR during charging, and immediately resume CPR after shock

administered (no pulse or rhythm check). • Rotate compressors every 2 minutes.

• Avoid excessive ventilation. Provide no more than 8-10 ventilations per minute. • Ventilations should be about one second each, enough to cause visible chest rise. • If advanced airway placed, perform CPR continuously without pauses for ventilation.

• If available, ResQPOD impedance threshold device may be used with BLS airway or King / ET tube. • If utilizing Endotracheal Tube, minimize CPR interruptions by positioning airway and laryngoscope, and

performing airway visualization prior to cessation of CPR for tube passage. Immediately resume CPR after passage.

• Confirm placement of advanced airway (King Airway or ET tube) with end-tidal carbon dioxide measurement. Continuous monitoring with ETCO2 is mandatory – if values less than 10 mm Hg seen, assess quality of compressions for adequate rate and depth. Rapid rise in ETCO2 may be the earlist indicator of return of circulation.

• Prepare drugs before rhythm check and administer during CPR • Follow each drug with 20 ml NS flush

A5 ADULT PULSELESS ELECTRICAL ACTIVITY / ASYSTOLE

INITIAL CARE See Cardiac Arrest – Initial Care and CPR (A3)

EPINEPHRINE 1:10,000 1 mg IV or IO every 3-5 minutes

Consider treatable causes – treat if applicable: Consider FLUID BOLUS For hypovolemia: 500-1000 ml NS IV or IO

VENTILATION For hypoxia: Ensure adequate ventilation (8-10 breaths per minute)

Consider SODIUM BICARBONATE

For pre-existing acidosis (e.g. kidney failure), hyperkalemia, or tricyclic antidepressant overdose are suspected: • 1 mEq/kg IV or IO if indicated • Should not be used routinely in cardiac arrest

Consider CALCIUM CHLORIDE

For hyperkalemia or calcium channel blocker overdose: • 500 mg IV or IO – may repeat in 5-10 minutes • Should not be used routinely in cardiac arrest

WARMING MEASURES For hypothermia

Consider NEEDLE THORACOSTOMY For tension pneumothorax

If Return of Spontaneous Circulation, see Post-Cardiac Arrest Care (A11)

Consider TERMINATION OF RESUSCITATION

Patients who have all of the following criteria are highly unlikely to survive: • Unwitnessed Arrest and • No bystander CPR and • No shockable rhythm seen and no shocks delivered during resuscitation and • No return of spontaneous circulation (ROSC) during resuscitation Patients with asystole or PEA whose arrests are witnessed and/or who have had bystander CPR administered have a slightly higher likelihood of survival. If unresponsive to interventions these patients should be considered for termination of resuscitation.

Key Treatment Considerations • Atropine is no longer used in cardiac arrest. • Pre-existing acidosis or hyperkalemia should be suspected in patients with renal failure or dialysis or if

suspected diabetic ketoacidosis

A6 - ADULT SYMPTOMATIC BRADYCARDIA - Heart rate less than 50 with signs or symptoms of poor perfusion (e.g., acute altered mental status, hypotension, other signs of shock). Correction of hypoxia should be addressed prior to other treatments. OXYGEN High flow. Be prepared to support ventilation as needed CARDIAC MONITOR

IV TKO. If not promptly available, proceed to external cardiac pacing. Consider IO ACCESS if patient in extremis and unconscious or not responsive to painful stimuli.

12-LEAD ECG Consider pre- and post-treatment if condition permits TRANSCUTANEOUS PACING

Set rate at 80 Start at 10 mA, and increase in 10 mA increments until capture is achieved

Consider SEDATION

If pacing urgently needed, sedate after pacing initiated. • MIDAZOLAM - initial dose 1 mg IV or IO, titrated in 1-2 mg increments

(maximum dose 5 mg), and/or • MORPHINE SULFATE 1-5 mg IV or IO in 1 mg increments for pain relief if BP

90 systolic or greater

Consider ATROPINE

May be used as a temporary measure while awaiting transcutaneous pacing but should not delay onset of pacing. • 0.5 mg IV or IO if availability of pacing delayed or pacing ineffective • Consider repeat 0.5 mg IV or IO every 3-5 minutes to maximum of 3 mg Use with caution in patients with suspected ongoing cardiac ischemia. Atropine should not be used in wide-QRS second- and third-degree blocks.

TRANSPORT Consider FLUID BOLUS 250-500 ml NS if clear lung sounds and no respiratory distress

Consider DOPAMINE Begin infusion at 5 mcg/kg/min if not responsive to pacing or atropine (see table)

Key Treatment Considerations • Sinus bradycardia in the absence of key symptoms requires no specific treatment (monitor / observe)

• Sedation prior to starting pacing is not required. Patients with urgent need should be paced first.

• The objective of sedation in pacing is to decrease discomfort, not to decrease level of consciousness. Patients who are in need of pacing are unstable and sedation should be done with great caution.

• Monitor respiratory status closely and support ventilation as needed

• Atropine is not effective for bradycardia in heart-transplant patients (no vagus nerve innervation in these patients)

• Patients with wide-QRS second- and third-degree blocks will not have a response to atropine because these heart rates are not based on vagal tone. An increase in ventricular arrhythmias may occur.

A7 ADULT

VENTRICULAR TACHYCARDIA WITH PULSES Widened QRS Complex (greater than or equal to 0.12 sec) – generally regular rhythm

INITIAL THERAPY OXYGEN High flow. Be prepared to support ventilation as needed.

CARDIAC MONITOR

12-LEAD ECG Consider pre- and post treatment if condition permits IV TKO

STABLE VENTRICULAR TACHYCARDIA AMIODARONE 150 mg IV over 10 minutes (intermittent IV push or IV infusion of 15 mg/min)

Consider repeat AMIODARONE If rhythm persists and patient remains stable, 150 mg IV over 10 minutes

UNSTABLE VENTRICULAR TACHYCARDIA • Poor perfusion, moderate to severe chest pain, dyspnea, blood pressure less than 90 or CHF Consider SEDATION

Prepare for CARDIOVERSION: If awake and aware, sedate with MIDAZOLAM - initial dose 1 mg IV, titrate in 1-2 mg increments (max. dose 5 mg)

SYNCHRONIZED CARDIOVERSION

100 joules (low energy setting – 75 W/S) 200 joules (low energy setting – 120 W/S) 300 joules (low energy setting – 150 W/S) 360 joules (low energy setting – 200 W/S) If VT recurs, use lowest energy level previously successful

Key Treatment Considerations • Document rhythm during treatment with continuous strip recording • Rhythm analysis should be based on recorded strip, not monitor screen

• Be prepared for previously stable patient to become unstable

• Give AMIODARONE via Infusion or slow IV push only • Caution with administration of AMIODARONE. May cause hypotension, especially if given rapidly. • AMIODARONE should not be used in unstable patients. Patients with pre-existing hypotension should

be considered unstable and should not receive AMIODARONE.

• If sedation done for cardioversion, monitor respiratory status closely and support ventilations as needed

A8 ADULT SUPRAVENTRICULAR TACHYCARDIA

• Heart rate greater than 150 beats per minute – regular rhythm usually with narrow QRS complex

INITIAL THERAPY OXYGEN High flow. Be prepared to support ventilation as needed.

CARDIAC MONITOR 12-LEAD ECG Consider pre- and post-treatment if condition permits

IV TKO – Antecubital IV needed for rapid medication administration

STABLE SUPRAVENTRICULAR TACHYCARDIA (SVT) • May have mild chest discomfort VALSALVA Consider ADENOSINE

6 mg rapid IV - followed by 20 ml normal saline flush If not converted, 12 mg rapid IV 1-2 minutes after initial dose, followed by 20 ml normal saline flush.

UNSTABLE SVT • May need immediate synchronized cardioversion • Signs of poor perfusion include moderate to severe chest pain, dyspnea, altered mental status,

blood pressure less than 90 or CHF • If rhythm not regular, SVT unlikely • If wide QRS complex, consider ventricular tachycardia

Consider ADENOSINE

6 mg rapid IV - followed by 20 ml normal saline flush. If not converted, 12 mg rapid IV 1-2 minutes after initial dose, followed by 20 ml normal saline flush.

Consider SEDATION

Prepare for CARDIOVERSION. If awake and aware, sedate with MIDAZOLAM - initial dose 1 mg IV, titrate in 1-2 mg increments (max. dose 5 mg)

SYNCHRONIZED CARDIOVERSION

100 joules (low energy setting – 75 W/S) 200 joules (low energy setting – 120 W/S) 300 joules (low energy setting – 150 W/S) 360 joules (low energy setting – 200 W/S)

Key Treatment Considerations • Document rhythm during treatment with continuous strip recording • Rhythm analysis should be based on recorded strip, not monitor screen • Be prepared for previously stable patient to become unstable • Proceed to cardioversion if patient becomes unstable • Adenosine should not be administered to patients with acute exacerbation of asthma • Hypoxemia is a common cause of tachycardia. Initial evaluation should focus on determining if

oxygenation is adequate. • If sedation used for cardioversion, monitor respiratory status closely and support ventilation as needed

A9 ADULT OTHER CARDIAC DYSRHYTHMIAS

SINUS TACHYCARDIA – Heart rate 100-160, regular ATRIAL FIBRILLATION – Heart rate highly variable, irregular ATRIAL FLUTTER – Variable rate depending on block. Atrial rate 250-350, “saw-tooth” pattern

INITIAL THERAPY OXYGEN Low flow. High flow if unstable. CARDIAC MONITOR Consider 12-LEAD ECG 12-lead ECG pre- and post-treatment if patient symptomatic and condition permits

Consider IV TKO UNSTABLE ATRIAL FIBRILLATION OR ATRIAL FLUTTER

Ventricular rate greater than 150, and: BP less than 80, or unconsciousness / obtundation, or severe chest pain or severe dyspnea OXYGEN High flow. Be prepared to support ventilation. Consider SEDATION

Prepare for CARDIOVERSION. If awake and aware, sedate with MIDAZOLAM - initial dose 1 mg IV, titrate in 1-2 mg increments (max. dose 5 mg)

SYNCHRONIZED CARDIOVERSION

Atrial Flutter: • Initial: 100 joules (low energy setting – 75 joules) • Subsequent: 200, 300, 360 joules (low energy settings 120, 150, 200 joules)

Atrial Fibrillation • Initial: 200 joules (low energy setting – 120 joules) • Subsequent: 300, 360 joules (low energy settings 150, 200 joules)

Key Treatment Considerations

• Sinus tachycardia commonly present because of pain, fever, anemia, or hypovolemia

• Atrial fibrillation may be well-tolerated with moderately rapid rates (150-170) and often requires no specific treatment other than observation (oxygen, monitoring and transport)

• If sedation used for cardioversion, monitor respiratory status closely and support ventilation as needed

• Computerized rhythm analysis on 12-lead ECG is frequently incorrect and requires review of the ECG to verify rhythm

• Computerized analysis for Acute MI (STEMI) may be incorrect with very fast rhythms. If ***Acute MI***, ***Acute MI Suspected*** or ***Meets ST-Elevation MI Criteria*** message encountered, the patient’s heart rate is important information to relate to the STEMI center at time of activation.

A10 ADULT SHOCK

HYPOVOLEMIC OR SEPTIC SHOCK - Signs and symptoms of shock with dry lungs, flat neck veins • May have poor skin turgor, history of GI bleeding, vomiting or diarrhea • May be warm and flushed, febrile • May have history of high fever (sepsis)

SHOCK (NOT CARDIOGENIC) OXYGEN High flow. Be prepared to support ventilations as needed.

Keep patient warm

CARDIAC MONITOR Treat dysrhythmias per specific treatment guideline

EARLY TRANSPORT CODE 3

IV or IO

FLUID BOLUS 250-500 ml NS Recheck vitals every 250 ml to a maximum of 1 liter

BLOOD GLUCOSE Check and treat if indicated

Consider DOPAMINE Begin infusion at 5 mcg/kg/min if hypotension persists (see table)

Related guidelines: Altered level of consciousness (G2), Respiratory Depression or apnea (G12)

CARDIOGENIC SHOCK • Signs and symptoms of shock, history of CHF, chest pain, rales, shortness of breath, pedal edema

OXYGEN High flow. Be prepared to support ventilations as needed.

Keep patient warm

CARDIAC MONITOR Treat dysrhythmias per specific treatment guideline

EARLY TRANSPORT CODE 3

IV or IO TKO

BLOOD GLUCOSE Check and treat if indicated

Consider DOPAMINE Begin infusion at 5 mcg/kg/min if hypotension persists (see table)

12–LEAD ECG Perform if time and condition permits

Related guideline: Altered Level of Consciousness (G2)

A11 ADULT POST-CARDIAC ARREST CARE

Following resuscitation from cardiac arrest in adults

OXYGEN Titrate to keep oxygen saturation above or equal to 94%. Be prepared to support ventilations as needed. Avoid excessive ventilation.

END-TIDAL CO2 MONITORING If intubated, monitor and maintain respirations to keep ETCO2 between 35 and 40

CARDIAC MONITOR Treat dysrhythmias per specific treatment guideline

12-LEAD ECG Evaluate for possible STEMI. Alert and transport to STEMI center if ECG indicates ***ACUTE MI*** or equivalent STEMI message

TRANSPORT CODE 3

IV or IO If not previously established

BLOOD GLUCOSE Treat if indicated Consider FLUID BOLUS For BP less than 90 systolic, begin infusion up to 1 liter NS

Consider DOPAMINE Begin infusion at 5 mcg/kg/min if hypotension persists after fluid bolus (see table)

Consider THERAPEUTIC HYPOTHERMIA

See Indications and contraindications below. Expose patient and apply eight (8) ice packs • 2 on head, 2 on the neck over the carotid arteries, 1 on each axilla, 1 over

each femoral artery Discontinue ice packs if shivering occurs or increasing level of consciousness Advise Emergency Department that hypothermia has been initiated.

THERAPEUTIC HYPOTHERMIA – INDICATIONS AND CONTRAINDICATIONS

INDICATIONS

All the following must be present: • Must be age 18 or greater • Return of spontaneous circulation for at least five minutes • GCS < 8 • Unresponsive without purposeful movements. Brainstem reflexes and

posturing movements may be present • Blood pressure 90 systolic or greater • Pulse oximetry – 85% or greater • Blood glucose – 50 or greater

CONTRAINDICATIONS

• Traumatic cardiac arrest • Responsive post-arrest with GCS 8 or greater or rapidly improving GCS • Pregnancy • DNR or known terminal illness • Dialysis patient • Uncontrolled bleeding

• Consider and treat other potential causes of altered level of consciousness (e.g. hypoxia or hypoglycemia)

A12 ADULT

PUBLIC SAFETY DEFIBRILLATION BLS / LAW ENFORCEMENT

SCENE SAFETY / BSI Use universal blood and body fluid precautions at all times

CONFIRM Unconscious, pulseless patient with no breathing or no normal breathing

COMPRESSIONS

• Begin compressions at a rate of at least 100 per minute • Compress chest at least 2 inches and allow full recoil of chest (lift heel of hand) • Change compressors every 2 minutes • Minimize interruptions in compressions. If necessary to interrupt, limit to 10

seconds or less • Stop compressions for analysis only – resume compressions while AED is charging • Resume compressions immediately after any shock • If available, place mechanical compression device after first rhythm analysis or

after subsequent rhythm analysis (LUCAS or Auto-Pulse)

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

• Priority of second rescuer is to apply pads while compressions are in progress • If less than 8 years of age, attach pediatric electrodes, if available. If not, attach adult

electrodes with anterior-posterior placement (pads should not touch) • (*) Allow AED to analyze heart rhythm

o If the rhythm is shockable Resume compressions until charging of unit is complete Clear bystanders and crew (stop compressions) Deliver shock Resume CPR for 2 minutes, beginning with chest compressions – then return to (*)

o If the rhythm is NOT shockable (“No Shock Advised”) Resume CPR for 2 minutes, beginning with chest compressions – then return to (*)

BASIC AIRWAY MANAGEMENT AND VENTILATION

• Open airway and provide 2 breaths after every 30 compressions • AVOID EXCESSIVE VENTILATION – Provide no more than 8 –10 ventilations per minute • Ventilations should be about one second each, enough to cause visible chest rise • Use two-person BLS Airway management (one holding mask and one squeezing bag –

compressor can squeeze the bag)

If patient begins to breathe or becomes responsive

• Maintain airway • Assist ventilations, as necessary • Check blood pressure, if equipment available