Warn all other individuals to stand clear and remove any oxygen delivery device whilst the defibrillator is charged to 150 J.After two minutes, pause CPR to check the rhythm on recognising a shockable rhythm, resume chest compressions immediately.Resume CPR immediately and continue for two minutes.Once the defibrillator is charged, instruct the individual performing chest compressions to stand clear and then deliver the first shock.Warn all other individuals to stand clear and remove any oxygen delivery device whilst the defibrillator is charged to 150 J (this is the value on most machines, check local protocols).On recognising a shockable rhythm, resume chest compressions immediately.Management of shockable rhythms (VF and pulseless VT) Attach defibrillator pads and pause CRP to analyse the rhythm further management will depend of whether the rhythm is shockable (ventricular fibrillation or pulseless ventricular tachycardia ) or non-shockable (asystole or pulseless electrical activity ).Ventilations should ideally be applied via a bag-valve-mask (BVM) attached to an oxygen supply, but if these are unavailable can be given via a pocket mask or mouth-to-mouth.If there is no pulse, no signs of life, or if in any doubt, commence cardiopulmonary resuscitation (CPR) immediately in a ratio of 30 compressions to 2 ventilationcompressions should be applied to the lower half of the sternum to a depth of 5-6 cm at a rate of 100 per minute.If there is a risk of a cervical spine injury, open the airway using a jaw thrust whilst an assistant applies manual in-line stabilisation (MILS).Open the airway with a head tilt/chin lift manoeuvre, palpate the carotid pulse and look, listen and feel for breathing for 10 seconds.Shout: if the patient responds, assess them from an ABCDE perspective if they do not respond, shout for help and put out a cardiac arrest call.Shake: ask the patient “Are you alright?” whilst shaking their shoulder.On finding an unconscious individual, follow the three SSS’s: safety, shake, shout.
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