The Chain of Survival
The chain of survival consists of early recognition and activation, early CPR, early defibrillation, early advanced care, and post-cardiac arrest care. Each link in the chain is critical. The NREMT tests your understanding of how each link contributes to patient survival and what happens when a link is broken or delayed.
High-Performance CPR
Effective chest compressions are the foundation of cardiac arrest management. Compress at a rate of 100 to 120 compressions per minute. Compress to a depth of at least 2 inches (5 cm) in adults, about 2 inches (5 cm) in children, and 1.5 inches (4 cm) in infants. Allow full chest recoil between compressions. Minimize interruptions in compressions to less than 10 seconds. Switch compressors every 2 minutes to prevent fatigue-related decline in compression quality.
AED Application and Use
Apply the AED as soon as it is available. Do not delay CPR to wait for the AED, but do not delay AED application to perform more CPR. Place pads in the anterior-lateral position: one pad to the right of the sternum below the clavicle, one pad on the left side of the chest in the midaxillary line. Clear the patient before analyzing and before delivering a shock. Resume CPR immediately after a shock is delivered without checking for a pulse.
Special Situations
For drowning victims, provide 2 rescue breaths before beginning compressions because the arrest is likely respiratory in origin. For hypothermic patients, provide CPR and limit defibrillation attempts; rapid rewarming is a priority. For pediatric patients, use pediatric AED pads if available; if not, use adult pads and ensure they do not overlap. For pregnant patients in cardiac arrest, perform CPR with manual left uterine displacement to relieve aortocaval compression.
Team Dynamics
Effective cardiac arrest management requires clear role assignments, closed-loop communication, and team coordination. The team leader assigns roles, monitors CPR quality, and makes clinical decisions. Team members communicate their actions, request clarification when needed, and share relevant information. The NREMT expects you to understand how team dynamics contribute to resuscitation outcomes.