What should be done for an unconscious patient with a heart murmur after an accident?

Management of an Unconscious Accident Patient

Immediately assess for cardiac arrest by checking responsiveness and breathing simultaneously—if the patient is unconscious with absent or abnormal breathing (including gasping/"murmur lips"), assume cardiac arrest and begin CPR immediately. 1

Initial Assessment (First 10 Seconds)

Check responsiveness and breathing together:

• Tap the patient's shoulders and shout "Are you all right?" 1
• Simultaneously look for chest movements, listen for breath sounds, and feel for air movement 1
• Healthcare providers should check for a carotid pulse, but spend no more than 10 seconds doing so 2, 3

Critical recognition point: Gasping respirations (which may appear as "murmuring lips") occur in 40-60% of cardiac arrest victims and are commonly misinterpreted as adequate breathing. 2, 3 These agonal breaths appear as slow, irregular gasping that is ineffective for ventilation. 2

Immediate Actions Based on Findings

If No Pulse or Uncertain Pulse + Abnormal/Absent Breathing:

Assume cardiac arrest and act immediately:

1. Activate emergency response system (call 911 or facility emergency number) 1

2. Begin high-quality CPR immediately: 1, 3

   • Compress at least 100-120 times per minute 1
   • Push hard: compress at least 2 inches (5 cm) deep 1
   • Allow complete chest recoil between compressions 1
   • Minimize interruptions in compressions 1
   • Use 30 compressions to 2 breaths ratio 1, 3

3. Get a defibrillator as soon as possible - ventricular fibrillation is the most common initial rhythm in adult cardiac arrest, and early defibrillation is the only intervention that unequivocally improves survival 1

The risk of performing CPR on someone not in cardiac arrest is low and does not outweigh the benefit of early intervention. 2 Early CPR improves survival by 2- to 3-fold. 2

If Pulse Present + Not Breathing:

1. Open the airway using head tilt-chin lift maneuver 1
2. Provide rescue breathing: Give 10 breaths of mouth-to-mouth or bag-valve-mask ventilation 1
3. Call for help immediately 1
4. Continue ventilations at 1 breath every 6 seconds (10 breaths/minute) 3

If Pulse Present + Breathing Spontaneously:

1. Place in recovery position to prevent airway obstruction and aspiration 1
   • Position on side with head dependent 1
   • Ensure the position is stable and does not impair breathing 1
2. Call for emergency help 1
3. Monitor continuously for changes in breathing or pulse 1

Regarding the Heart Murmur

The presence of a heart murmur is irrelevant to immediate trauma management. Heart murmurs are present in up to 52% of adults and most are innocent (non-pathologic). 4, 5 In an unconscious trauma patient, the priority is airway, breathing, and circulation—not cardiac auscultation. The murmur can be evaluated after the patient is stabilized. 4, 6

Common Pitfalls to Avoid

• Do not mistake agonal gasping for normal breathing - this is the most common error leading to delayed resuscitation 2, 7
• Do not spend excessive time checking for a pulse - if uncertain after 10 seconds, begin CPR 2, 3
• Do not delay CPR to obtain equipment - start compressions immediately with what you have 1
• Do not be distracted by the heart murmur - focus on life-threatening issues first 4