For a patient experiencing a cardiac arrest, which of the following steps should be taken first?

NHM MP Staff Nurse - 2015

Medical Surgical Nursing

Medium

Appeared in: NHM MP Staff Nurse - 2015

Explanation

The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) prioritize actions using the C-A-B sequence: Chest Compressions, Airway, and Breathing.
While initiating high-quality chest compressions is the absolute first step in managing a pulseless patient, it is not listed as an option.
Among the given choices, establishing an open airway is the next critical action after starting compressions.
An open airway is essential to deliver rescue breaths and oxygenate the blood being circulated by chest compressions, which is vital for brain and organ survival.

Option A: This is a critical step but follows the initiation of high-quality CPR. The primary purpose is to analyze the rhythm and determine if defibrillation is needed, but it should not delay chest compressions and airway management.
Option B: Establishing intravenous (IV) or intraosseous (IO) access is an Advanced Cardiovascular Life Support (ACLS) intervention. It is necessary for medication administration but is performed after effective BLS (compressions and airway/breathing) has been established.
Option D: Pulse oximetry is unreliable in cardiac arrest due to poor or absent peripheral circulation. It is not a priority action and provides no useful data in this initial phase. Capnography is the preferred monitoring tool for CPR quality.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Priorities in Basic Life Support (BLS) for cardiac arrest in acute care settings.
In a cardiac arrest, the immediate goal is to restore circulation and oxygenation. The C-A-B sequence ensures that life-sustaining chest compressions are started with minimal delay.
Nurses must be able to initiate BLS instinctively. Delaying compressions to find equipment for IV access or monitoring significantly worsens the patient's chance of survival.
What if? If the patient was a witnessed drowning victim, the priority might shift to providing initial rescue breaths before starting compressions, as the arrest is likely due to hypoxia. However, for most adult arrests, C-A-B remains the standard.

How to Approach the Question

First, identify the question as a priority-setting question ('which...step should be taken first?').
Recall the standard algorithm for the clinical scenario, which is cardiac arrest. The relevant algorithm is Basic Life Support (BLS).
Apply the C-A-B mnemonic: Compressions, Airway, Breathing. This represents the order of priority.
Analyze the options. 'Chest compressions' is not an option. The next step in the sequence is 'Airway'.
Select the option that corresponds to 'Airway': 'Establish an open airway'.
Mentally verify that the other options (monitoring, IV access, oximetry) are performed later in the BLS/ACLS sequence, confirming your choice.

Concept Tested & Keywords

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