Adult Basic Life Support

The Chain of Survival is a series of actions that increases the chances of a patient surviving a cardiac arrest. This is predominantly about the resuscitation of patients in an acute hospital; however, the initial resuscitation of patients is similar in any clinical setting and the same standards apply.

Early recognition and call for help

The deteriorating patient is recognised early and there is an effective system to summon help in order to prevent cardiorespiratory arrest.

Early CPR

Cardiorespiratory arrest is recognised early and CPR is started immediately.

If not done so already, help is immediately called as soon as cardiorespiratory arrest is recognised.

Early defibrillation

Defibrillation, if appropriate, is attempted within 3 minutes of identifying cardiorespiratory arrest.

Post-resuscitation care

Post-cardiac arrest care is received by those who are resuscitated successfully. This includes safe transfer.

We have discussed what you should do when you are confronted with a patient and there are signs of life. We are now going to look at what to do when there aren’t any signs of life.

Approach

Approach with care

Shout for help

Person is unresponsive and not breathing normally - shout for help.

Open the airway

Open the airway using head tilt and chin lift. Check for breathing and signs of life.

If you are unsure, treat the person as being in cardiac arrest.

Call for help

State your location and repeat.

Chest compressions

Carry out 30 chest compressions.

Rescue breaths

Give the patient two rescue breaths.

In clinical settings use a pocket mask or bag-valve-mask device.

Continue CPR

Continue CPR - 30 chest compressions then two breaths.

Automated external defibrillator (AED)

As soon as the AED arrives, switch it on and follow instructions.

In the Community

In the community setting there are other considerations that need to be taken into account:

Approach with care as there may be more hazards such as traffic or live electrical cables etc.
Don't forget to shout for help or ask a bystander to call for help for you; tell them they need to state that it is an adult cardiac arrest and the location
Mouth to mouth is optional; perform continuous chest compressions if you are not going to perform mouth to mouth
Ask bystanders to help you perform CPR and supervise them to make sure they are performing it correctly
In the community there are often Public Access Defibrillators (PAD) which anyone can use in an emergency. If there is one nearby, ask for it to be brought to you

Neck Breathers

For patients with neck breathers, do the following:

Head tilt and chin lift
Observe the tracheostomy tube/permanent stoma site for patency and remove any potential obstruction
Check breathing for up to 10 seconds

Select the headings below to find out more.

Look

Look for chest movement. Remember that in complete airway obstruction there may be paradoxical breathing but no air movement.

Is the tracheostomy tube in the correct position?

Do you need to change the tracheostomy inner tube?

Are there other signs of life?

Listen

Listen at the opening of the tracheostomy tube/permanent stoma site for movement of air.

Feel

Feel at the opening of the tracheostomy tube/permanent stoma site.

Using a catheter mount, connect the bag and valve to the tracheostomy tube. As the airway is secured, once the bag valve is connected, ventilation can be a single-person technique.

During rescue breathing, observe for chest movement. If the breath is effective the chest should rise and fall.

For more information see National Tracheostomy Safety Project website.

Pregnancy

During pregnancy there are several physiological changes that affect how resuscitation is performed. However, it is still essential that you perform basic life support and ask for the cardiac arrest team, maternity crisis team and neonatal crisis team to be called. Please see your local policy for guidance.

When performing CPR the patient remains on her back unless she is on a theatre table which can be tilted. The uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be manually displaced to the woman's left side.

It can be difficult to get breaths into the woman as the enlarged abdomen will put pressure on the diaphragm and the stomach. Intubation should be carried out by a trained professional/doctor who is competent in this skill as soon as possible. If the patient is intubated, then chest compressions should be performed continuously until instructed to stop by the AED or cardiac arrest team leader.

Peri-mortem caesarian section may be performed.

Automated External Defibrillator (AED)

AEDs deliver a therapeutic dose of electrical energy to the heart.

You must check your local cardiopulmonary policy for your roles and responsibilities regarding this equipment.

Select the headings to find out more.

Instructions

Open the AED, switch it on and follow the spoken/visual instructions on how to use it. A semi-automatic AED indicates if a shock is needed which should be delivered by the operator.

Safety

When attaching pads you must:

Cut off the clothes to expose the chest
Dry the chest of any fluids
Move jewellery out of the way
Remove any drug patches
Check for pacemakers (if the pacemaker is on the right-hand side, place pads front and back)

Pads

Pads

Place the first pad on the patient's upper right side, just below their collarbone as shown on the pad
Place the second pad on the left mid-axillary line as indicated by the picture on the pad. Breast tissue should be avoided. Make sure you position the pad lengthways, with the long side in line with the length of their body
Chest compressions should continue whilst pads are applied

Shock

Shocking the patient

If a shock is indicated, ensure that everyone is clear of the patient and ensure all free-flowing oxygen is removed. Everyone should be at least 1 metre away from the patient
Push the shock button as directed
Immediately restart CPR at a ratio of 30:2
Continue as directed by the voice/visual prompts

If no shock is indicated, continue CPR until prompted to stop by the AED or the patient shows signs of life.

Choking in an Adult

It is important to know what to do when a person appears to be choking. Follow these steps:

Ask them if they are choking, If they are able to speak, then ask them to cough
- Effective cough: encourage coughing and observe carefully for signs of tiredness/deterioration
- Cannot cough (they just nod to confirm they are choking) or ineffective cough, then ask for the cardiac arrest team to be called
Give up to five back blows; aim for the centre of the back at shoulder-blade level, hitting the patient hard with a flat hand
If unsuccessful, give up to five abdominal thrusts. Stand behind the patient, make a fist with one hand just below the ribs and cup it with your other hand, pull in and up beneath the ribs sharply. Repeat up to five times
If unsuccessful, then repeat the five back blows followed by five abdominal thrusts
If the airway is cleared, the patient should be assessed by a doctor if abdominal thrusts have been given
If the choking patient collapses, perform basic life support

Modifications to Adult BLS for Children

If in doubt use adult BLS guidelines on a child and call for specialist help.

The same steps can be followed for resuscitation of children by those who are not specifically trained in resuscitation for children - it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing.

For more detail, refer to the session Resuscitation Paediatric Level 2.

Select the two images below to review resuscitation guidelines for an infant and a child.

Infant

For an infant under 1 year, the head should be in a neutral position
Give five initial rescue breaths, two of which must be successful, before starting chest compressions. If you do not achieve chest movement check the airway is clear, the head and chin position and ensure you have a good seal
If no signs of life, then use two fingers to compress the chest by at least 1/3 of its depth (depth of 4 cm for an infant) over the centre/lower third of the sternum
If you are on your own, continue basic life support for 1 min (continue to shout for help when performing CPR) before going for help

Child

For a child (from 1 year up to puberty) use a slight head tilt and a chin lift.
Give five initial rescue breaths, two of which must be successful, before starting chest compressions. If you do not achieve chest movement check the airway is clear, the head and chin position and ensure you have a good seal
If no signs of life then use one or two hands (as required to achieve an adequate depth of compression) to compress the chest by at least 1/3 of its depth (depth of 5cm for a child) over the centre/lower third of the sternum
If you are on your own, continue basic life support for 1 min (continue to shout for help when performing CPR) before going for help

Do Not Attempt Cardiopulmonary Resuscitation Order (DNACPR)

It is your responsibility to know and comply with your organisation’s Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy as all organisations' forms may be different.

A signed record of the order must be available to all concerned with the patient’s care. You need to ensure that the notes and form accompany the patient if they go to a different department in your hospital.

You should also familiarise yourself with the treatment escalation plan or the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process which creates individualised recommendations for a person’s clinical care in emergency situations.

Session Summary

Key Points

Early recognition of the deteriorating patient and prevention of cardiac arrest increases the chances of a patient surviving a cardiac arrest
If you find a collapsed or sick individual, you must first ensure your personal safety before assessing whether the patient is responsive
If the patient is responsive, you should carry out an ABCDE assessment; if the patient is not responsive and is not breathing normally, you should start CPR
Early defibrillation, if appropriate, should be attempted within 3 minutes of identifying cardiorespiratory arrest
You have a responsibility for ensuring that your knowledge regarding all aspects of resuscitation is kept up to date and complies with your organisation's mandatory training requirements
You should only carry out resuscitation interventions within the limits of your personal capabilities and context of any previous training received

Next Steps

You have completed the Adult Basic Life Support chapter which is the final chapter in this learning.

Continue to the Resuscitation Adult Level 2 eAssessment.

This should be completed to demonstrate the required knowledge and understanding and to complete the training.

Remember to also familiarise yourself with local procedures.

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