What should the nurse do first for a patient in ventricular fibrillation who suddenly stops breathing?

Management of a Patient in Ventricular Fibrillation Who Stops Breathing

The nurse should FIRST start CPR immediately for a patient who suddenly stops breathing and is in ventricular fibrillation. 1

Initial Assessment and Actions

When encountering a patient in ventricular fibrillation who suddenly stops breathing, follow this algorithm:

1. Verify scene safety before approaching the patient 1
2. Check for responsiveness by tapping the patient and calling out 1
3. Look for no breathing or only gasping and check pulse simultaneously (taking no more than 10 seconds to determine if pulse is present) 1
4. Start CPR immediately if there is no breathing (or only gasping) and no pulse is felt 1

CPR Technique

• Perform high-quality chest compressions:

  • Push hard (at least 2 inches/5 cm in adults) 1
  • Push fast (100-120 compressions per minute) 1
  • Allow complete chest recoil after each compression 1
  • Minimize interruptions in compressions 1

• For a single rescuer, perform cycles of 30 compressions and 2 breaths 1

• When a second rescuer arrives, perform cycles of 15 compressions and 2 breaths (for pediatric patients) or continue 30:2 for adults 1

Early Defibrillation

• Use an Automated External Defibrillator (AED) as soon as it becomes available 1
• Check rhythm to determine if it is a shockable rhythm (ventricular fibrillation is a shockable rhythm) 1
• If shockable, deliver 1 shock and immediately resume CPR for 2 minutes 1

Common Pitfalls to Avoid

• Delaying CPR initiation: Do not delay starting compressions while waiting for additional help or equipment 1, 2
• Inadequate compression depth: Ensure proper depth of at least 2 inches in adults 1
• Excessive interruptions: Minimize pauses in chest compressions, as each interruption reduces coronary perfusion pressure 1, 3
• Focusing on defibrillation before CPR: While early defibrillation is important, starting immediate CPR is the first priority when encountering a patient without breathing and pulse 1, 3

Evidence-Based Rationale

The 2020 American Heart Association guidelines emphasize the critical importance of immediate CPR initiation for patients in cardiac arrest 1. For patients in ventricular fibrillation who are not breathing, immediate chest compressions are essential to maintain blood flow to vital organs until defibrillation can be performed 1.

Research has demonstrated that each minute delay in defibrillation from the onset of cardiac arrest decreases the probability of survival by 10% 2. However, studies have also shown that providing CPR before defibrillation can improve outcomes, particularly when the response interval is 4 minutes or longer 3.

The nurse must prioritize starting CPR immediately to maintain perfusion to vital organs while the emergency response system is activated and an AED is retrieved 1.