What is the immediate management for a patient with sudden loss of consciousness and pulselessness, possible cause?

Immediate Management of Sudden Loss of Consciousness with Pulselessness

Start CPR immediately with chest compressions if no pulse is detected within 10 seconds of checking, as this represents cardiac arrest requiring immediate resuscitation to prevent death. 1

Initial Assessment and Recognition

The first critical steps must be performed rapidly and systematically:

• Verify scene safety before approaching the patient to avoid becoming a second victim 1, 2
• Check for responsiveness by shouting and tapping the victim 1, 2
• Activate the emergency response system immediately and retrieve an AED (or send someone to do so if multiple rescuers are present) 1
• Simultaneously assess breathing and pulse within 10 seconds—look for no breathing or only gasping while checking for a pulse 1, 2

A common pitfall is that healthcare providers often take too long to check for a pulse, leading to critical delays in starting compressions. 1 If you cannot definitively feel a pulse within 10 seconds, assume cardiac arrest and begin CPR immediately.

Immediate CPR Initiation

Once pulselessness is confirmed, begin high-quality CPR without delay:

• Perform chest compressions at a depth of 5-6 cm (at least 2 inches) in adults at a rate of 100-120 compressions per minute 1, 2
• Allow complete chest recoil between compressions—incomplete chest recoil prevents full cardiac refilling and is a critical error 1, 2
• Minimize interruptions in chest compressions, as continuous compressions are essential for survival 1, 2
• Use a compression-to-ventilation ratio of 30:2 for single rescuers (30 compressions followed by 2 breaths) 1, 2
• For untrained rescuers, compression-only CPR is acceptable and should be encouraged over no CPR 1

Early Defibrillation

• Use the AED as soon as it becomes available—do not delay CPR to retrieve it, but apply it immediately once present 1, 2
• Check the rhythm to determine if it is shockable (ventricular fibrillation or pulseless ventricular tachycardia) 1, 2
• If shockable, deliver one shock immediately and resume CPR for 2 minutes before reassessing the rhythm 1, 2
• If non-shockable, continue CPR for 2 minutes before rechecking the rhythm 1

Advanced Life Support Considerations

Once advanced providers arrive or IV/IO access is established:

• Check rhythm every 2 minutes during CPR 1
• Administer epinephrine every 3-5 minutes for all cardiac arrest rhythms 1
• Consider amiodarone or lidocaine for refractory ventricular fibrillation or pulseless ventricular tachycardia 1

Special Considerations for Specific Populations

For pediatric patients (if the context suggests this population):

• Use a compression-to-ventilation ratio of 30:2 for single rescuers and 15:2 for two or more rescuers 3, 4
• Compressions should be at least one-third of the anterior-posterior diameter of the chest 4

For suspected opioid overdose:

• Administer naloxone if available while continuing CPR 1

Critical Pitfalls to Avoid

• Do not delay CPR to obtain a detailed history—the priority is immediate chest compressions 1
• Do not perform prolonged pulse checks—if uncertain after 10 seconds, start CPR 1
• Do not provide inadequate compression depth or rate—compressions must be hard and fast to be effective 1, 2
• Do not lean on the chest between compressions—this prevents adequate cardiac refilling 1

The evidence strongly supports that immediate recognition and CPR initiation are the most critical determinants of survival from sudden cardiac arrest, with every minute of delay decreasing survival by approximately 10%. 5 The risk of injury from CPR in patients not actually in cardiac arrest is minimal (less than 2%), making the benefits of immediate action far outweigh potential harms. 6