A patient suddenly becomes unconscious and pulseless in the ED. What is the best approach to manage his cardiac arrest?

The management of cardiac arrest in a patient who becomes unconscious and pulseless requires immediate and effective action. The recommended approach, particularly in a setting like the emergency department (ED), emphasizes the importance of continuous chest compressions while also identifying and addressing treatable causes of cardiac arrest. This includes conditions such as hypoxia, hypovolemia, ischemia, electrolyte imbalances, and drug overdose, among others.

By reviewing treatable causes while performing cardiopulmonary resuscitation (CPR) and conducting diagnostic tests, healthcare providers can gather critical information that allows for more tailored and effective interventions. This dual approach maximizes the chances of a successful resuscitation by not only maintaining blood circulation through continuous CPR but also setting the stage for rapid identification of reversible factors contributing to the cardiac arrest.

In contrast, focusing solely on establishing an airway or administering medications without maintaining compressions would likely reduce the likelihood of restoring circulation. Furthermore, delivering a shock immediately in the presence of pulseless electrical activity (PEA) or asystole is not appropriate, as defibrillation is effective only for shockable rhythms, such as ventricular fibrillation or pulseless ventricular tachycardia. Finally, the administration of sodium bicarbonate during early CPR