Evidence-based strategies, clear plans, and smart practice that fit your life.
In October 2025 the American Heart Association published new Guidelines for CPR and Emergency Cardiovascular Care. The National Registry responded that exam items conflicting with the 2025 guidelines are removed from its examinations, and that new items aligned with them become operational over the following twelve to fifteen months. If you are testing now, study the 2025 version — and be wary of older review material that still teaches the 2020 answers.
Choking: back blows are back
| Patient | 2025 sequence (responsive, severe obstruction) |
|---|---|
| Adult | 5 back blows, then 5 abdominal thrusts — repeat |
| Child | Back blows alternating with abdominal thrusts |
| Infant | 5 back blows, then 5 chest thrusts — never abdominal thrusts |
| Late pregnancy, or too large to encircle | Back blows, with chest thrusts in place of abdominal thrusts |
CPR and ventilation
- Infant compressions: the two-finger technique is no longer recommended. Use the two-thumb encircling-hands technique, or the heel of one hand when you cannot encircle the chest.
- Breathing with a pulse: one breath every 6 seconds for an adult. The guidelines now say "breaths" rather than "rescue breaths".
- AED pads: adjusting or moving a bra to place pads correctly is acceptable — do not delay the shock.
- Opioid-associated arrest: a patient with no pulse gets CPR now. Naloxone must never delay compressions.
- Not routine: mechanical CPR devices (use them only when manual CPR is impractical) and head-up CPR.
Advanced resuscitation (AEMT and Paramedic)
- Vascular access: intravenous first; intraosseous if IV fails or is not feasible.
- Epinephrine timing: as early as possible in a non-shockable rhythm. In a shockable rhythm, after the first shock fails. Then every 3 to 5 minutes.
- Antiarrhythmics: amiodarone or lidocaine for VF or pulseless VT that persists after defibrillation.
- Double sequential or vector-change defibrillation: the benefit is not established, so it is not routine.
- After ROSC: keep the mean arterial pressure at 65 mm Hg or above. In a patient who does not follow commands, control temperature between 32 and 37.5 °C for at least 36 hours. Do not hyperventilate.
The newborn
- Cord clamping: in a vigorous newborn, defer it for at least 60 seconds.
- Positive-pressure ventilation: 30 to 60 breaths a minute at about 20 to 30 cm H2O to start. Almost every newborn in trouble has a ventilation problem.
- Supraglottic airway: an acceptable alternative interface at 34 weeks' gestation or more.
How to study it
Most of the resuscitation content you already know is unchanged — compression rate and depth, minimizing pauses, and early defibrillation. The points above are where an old book or flashcard deck will now give you a wrong answer. CinnaEMS updated its choking items to the 2025 sequence and added a set of questions and flashcards that test each change directly; see also Primary Assessment, where most of the entry-level resuscitation items sit.