The first 90 seconds of a cardiac arrest set the ceiling on everything that follows. Long before the resus team is fully assembled, the person at the patient’s side is the one who decides whether the outcome is salvageable. This post is a short refresher on the moves we drill until they’re automatic — and a few of the human-factors traps that quietly undo them.
Start with what you can see
A collapsed patient is a sensory event before it is a clinical one. Safety, response, airway, breathing, circulation — the order matters, but so does naming each step out loud. “No response. No normal breathing. Starting CPR. Call resus.” Saying it makes it real for the people around you and prevents the awkward pause where everyone is waiting to see who moves first.
Compressions before everything else
Good compressions are the single highest-yield intervention in the first few minutes. Hard, fast, full recoil, and a metronome in your head. Everything else — airway management, IV access, drug rounds — is built on top of that foundation. If compressions are interrupted for longer than ten seconds, the rhythm-check budget has already been spent.
Use the algorithm — and then look up
The ACLS algorithm is a scaffold, not a script. Treat it as the default plan, then look up. Is this a shockable rhythm? Are the reversibles being chased? Who has eyes on the airway, who on access, who on drugs? The teams that perform best in mock-codes spend less time staring at the monitor and more time scanning the room.
If you want to drill these patterns properly — with feedback rather than just repetition — that’s what the BLS & ACLS sessions at EM for All are built around.
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