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DR’s ABCD
Danger: check around patient and environment for danger
Response: question (e.g. ‘Hello, can you hear me?’), shake and command (e.g. ‘Open your eyes’)
Shout: ‘help, help, help’ if unresponsive
Airway: open airway with head-tilt/chin-lift or jaw-thrust and look for/remove obstructions
Breathing: assess breathing for up to 10 seconds by listening and feeling with your ear, while watching for chest movements and palpating carotid pulse
NB: you should do this while maintaining the head-tilt/chin-lift or jaw-thrust (e.g. place your forearm on the patient’s forehead, apply positive pressure to tilt the head back, and reach around their face to pull up the angle of the jaw with the index and middle fingers, whilst palpating the carotid pulse with the other hand).
Head-tilt chin-lift
CPR and Call ambulance:
If patient is not breathing, start CPR (described in detail below) and ask a helper to call 999 and explain there is a cardiac arrest and the location
If there are no helpers, you must call yourself, ideally using a mobile speakerphone (leave the scene to call for help if you have to)
Also ask the helper if present to get an automated external defibrillator if one is available (but do not leave the scene yourself to get this)
Defibrillation:
If an automated external defibrillator arrives, attach the pads to the patient’s bare chest (one below right clavicle and one over cardiac apex)
If there is more than one rescuer, continue CPR while attaching electrodes. Follow the defibrillation spoken/visual prompts on the machine
AED pad placement
Cardiopulmonary resuscitation
Perform 30:2 chest compressions to rescue breaths. If there is another trained helper, take turns; if not, continue until you tire and can no longer physically continue. Perform CPR on a firm surface.
30 chest compressions
Perform at a rate of 100-120/minute and a depth of 5-6cm
You must fully extend your elbows, wrists and fingers
Have both hands palm downwards with fingers interlocked
Place the carpal area of the hand over the lower sternum and apply all of the pressure over this point
Compression technique
2 rescue breaths
At the patient’s side, place part of your palm and your little finger firmly on the patient’s forehead and occlude the nostrils using the index finger and thumb of the same hand
Perform a head-tilt, and lift the chin with the other hand. Now, with a good seal around the patient’s lips, breathe a normal expiration for 1 second, watching the patient’s chest to check it expands
NB: if you have a pocket mask, position yourself at the head of the patient and firmly press the mask around the patient’s face with the index finger and thumb of each hand on either side. Place your little fingers either side around the angle of the patient’s mandible to pull it up into the mask and then perform the 2 breaths while watching the chest.
Special cases
Algorithm differences in children
Pulse check
Infant (<1 year): feel brachial pulse
Children (>1 year): feel carotid pulse
Compression:ventilation ratio
At birth: 3:1 ratio
Infants/children: start with 5 rescue breaths, then 15:2 ratio
Compressions
Compress to at least one-third of the AP chest diameter
Infant (<1 year):
Encircling technique (preferred): performed by placing both thumbs flat on the lower sternum pointing towards the infant’s head and the fingers around the rib cage
Two-finger technique (may be easier if only one rescuer): compress the sternum with the tips of two fingers
Children (>1 year): as for an adult but only use one hand (unless need 2nd to achieve target depth)
If you are on your own, perform CPR for 1 minute before leaving to get help
Drowning
Give 5 initial ventilations first, then continue at normal 30:2 ratio
If you are on your own, perform CPR for 1 minute before leaving to get help
Dry the patient’s chest prior to defibrillation
Pregnancy
Manually displace the uterus to the left and add left-lateral tilt if possible (prevents aortocaval compression during CPR)
