DIFFERENTIAL DIAGNOSIS

As a diagnosis, cardiac arrest does not have a wide differential diagnosis, as it should be clear when a
patient is in arrest: they are unresponsive, with apnea and no palpable carotid pulse. However, carotid
pulse assessment is not always accurate, and agonal gasps may be confused with normal respiration,
potentially clouding the diagnostic picture. AHA guidance has focused on minimizing “type II” error; ie,
failing to diagnose arrest when it is actually present. It is critical to avoid this type of error in cardiac
arrest, as arrest patients have virtually no chance of survival without prompt resuscitative care, meaning
that false-negative diagnoses are universally fatal. For this reason, cardiac arrest has become a diagnosis
of assumption: one should assume it to be present in appropriate patients until proven otherwise. To
this end, pulse checks were completely removed from lay rescuer protocols in 2000, and have been de-
emphasized for health professionals as well. Similarly, EMS dispatchers have been trained to encourage
bystander CPR for all cases of suspected cardiac arrest rather than confirming arrest before beginning
resuscitation.