You encounter an unresponsive 30-year-old female lying in snow with no breathing and no pulse. Her hands are cold and stiff, skin cyanotic, abdomen warm. You should suspect cardiac arrest and do what?

• A. begin chest compressions
• B. give her rescue breaths
• C. transport
• D. stabilize her

Answer: (A)

Start chest compressions because when there is no pulse and no breathing, the heart isn’t delivering blood to vital organs. Chest compressions mechanically circulate oxygenated blood to the brain and heart, which is the most immediate way to preserve life until advanced care arrives. Rescue breaths are important, but without blood flow, they don’t reach the brain effectively; thus the priority is to generate perfusion now. Call for help and get an AED ready, and if trained, follow the CPR pattern (compressions with breaths) as you perform high-quality compressions. In a cold environment, this rule still applies—you don’t delay CPR while worrying about warming or transportation.