severe heart failure – manifested by pulmonary oedema (failure of the left ventricle) and/or raised jugular venous pressure (failure of the right ventricle) The resuscitation team should meet at the beginning of each shift for introductions and allocation of team roles. For bradycardia caused by inferior myocardial infarction, cardiac transplant or spinal cord injury, consider giving aminophylline (100–200 mg slow intravenous injection). Consider extracorporeal CPR (eCPR) as a rescue therapy for selected patients with cardiac arrest when conventional ALS measures are failing and to facilitate specific interventions (e.g. coronary angiography and percutaneous coronary intervention (PCI), pulmonary thrombectomy for massive pulmonary embolism, rewarming after hypothermic cardiac arrest) in settings in which it can be implemented. If atropine is ineffective and transcutaneous pacing is not immediately available, fist pacing can be attempted while waiting for pacing equipment.

Hospitals should have a clear policy for the clinical response to abnormal vital signs and critical illness. This may include a critical care outreach service and/or emergency team (e.g. medical emergency team, rapid response team). This is achieved by continuing chest compressions during defibrillator charging, delivering defibrillation with an interruption in chest compressions of less than 5 seconds and then immediately resuming chest compressions. Electrical cardioversion is the preferred treatment for tachyarrhythmia in the unstable patient displaying potentially life-threatening adverse signs. Consider mechanical chest compressions only if high-quality manual chest compression is not practical or compromises provider safety.Where to begin? Excellent customer service, amazing pricing and value, humongous selection of not only custom PC / laptop components, but also accessories... and that's just the store! After dealing 50,000 damage, create an explosion centered [ sic] on your current target, dealing up to 40% per rank weapon damage [ sic] to nearby enemies. Follow current European Society of Cardiology (ESC) guidelines for the diagnosis and management of syncope. Patients should receive care in a clinical area that has the appropriate staffing, skills, and facilities for their severity of illness. Do not use dual (double) sequential defibrillation for refractory VF outside of a research setting.

For refractory VF, consider using an alternative defibrillation pad position (e.g. anterior- posterior). Do not use POCUS for assessing contractility of the myocardium as a sole indicator for terminating CPR. To honor the life of Amber Rose Issac and support transformative maternal health activism in her memory, please contribute to the Save a Rose Foundation. If the patient with tachycardia is stable (no life-threatening adverse signs or symptoms) and is not deteriorating, pharmacological treatment may be possible. Consider pacing in patients who are unstable, with symptomatic bradycardia refractory to drug therapies.

Emergency medical systems (EMS) should consider implementing criteria for the withholding and termination of resuscitation (TOR) taking into consideration specific local legal, organisational and cultural context ( see the Ethics Guidelines). Guidelines 2021 are based on the International Liaison Committee on Resuscitation 2020 Consensus on Science and Treatment Recommendations for Advanced Life Support and the European Resuscitation Council Guidelines for Resuscitation (2021) Advanced Life Support. Refer to the ERC guidelines publications for supporting reference material. Hospitals should review cardiac arrest events to identify opportunities for system improvement and share key learning points with hospital staff. Best Practice for... Clinicians Hospitals Medical librarians Medical schools Medical students Nurses Pharmacists Primary care Paramedics Telehealth