Early defibrillation with concurrent high-quality CPR is critical to survival when sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia. The toxicity of cyanide is predominantly due to the cessation of aerobic cell metabolism. Symptoms typically occur within minutes, and findings may include arrhythmias, apnea, hypotension with bradycardia, seizures, and cardiovascular collapse.1 Lactic acidosis is a sensitive and specific finding.2,3 Immediate antidotes include hydroxocobalamin and nitrites; however, the former has a much better safety profile. The force from a precordial thump is intended to transmit electric energy to the heart, similar to a low-energy shock, in hope of terminating the underlying tachyarrhythmia. This is particularly true in first aid and BLS, where determination of the presence of a pulse is unreliable. 6. There are also no specific alterations to ACLS for patients with cardiac arrest from asthma, although airway management and ventilation increase in importance given the likelihood of an underlying respiratory cause of arrest. 1. Twelve observational studies evaluated NSE collected within 72 hours after arrest. For a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (ie, a respiratory arrest), in addition to providing standard BLS and/or ACLS care, it is reasonable for responders to administer naloxone. The writing group would also like to acknowledge the outstanding contributions of David J. Magid, MD, MPH. As with all AHA guidelines, each 2020 recommendation is assigned a Class of Recommendation (COR) based on the strength and consistency of the evidence, alternative treatment options, and the impact on patients and society (Table 1(link opens in new window)). However, there are several case reports of good maternal and fetal outcome with the use of TTM after cardiac arrest. There are differing approaches to charging a manual defibrillator during resuscitation. EEG patterns that were evaluated in the 2020 ILCOR systematic review include unreactive EEG, epileptiform discharges, seizures, status epilepticus, burst suppression, and highly malignant EEG. TTM between 32C and 36C for at least 24 hours is currently recommended for all cardiac rhythms in both OHCA and IHCA. total time of the compression-plus-decompression cycle)? 1. Success rates for the Valsalva maneuver in terminating SVT range from 19% to 54%. In patients with atrial fibrillation and atrial flutter in the setting of preexcitation, digoxin, nondihydropyridine calcium channel antagonists, -adrenergic blockers, and IV amiodarone should not be administered because they may increase the ventricular response and result in VF.