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Adult basic life support

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Produced using UK Resuscitation Council ‘Adult basic life support’ 2021

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).

  • 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.  

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.
  • 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)
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