Chapter 5. Basic life support
The Resuscitation Council (UK) algorithms for basic, advanced, paediatric and neonatal resuscitation can be accessed via their website at: www.resus.org.uk and are based on European and International consensus of the research evidence.
A patient’s best chance of survival occurs when the collapse is witnessed and basic life support (BLS) techniques are started immediately.
The main sign of cardiac arrest is the absence of normal breathing in a non-responsive patient.
The sequence of BLS for laypersons
1. Safety check: to ensure that rescuer, bystanders and patient are not in danger
2. Evaluation of the patient: to identify whether the patient is unresponsive and not breathing normally
3. Airway control: to obtain and maintain a patent airway
4. Circulatory support: to establish an artificial circulation by external cardiac compression
5. Ventilatory support: to establish artificial ventilation using exhaled air.
The algorithm recognises the importance of starting chest compressions as soon as cardiac arrest is suspected; for this reason circulatory support is placed before ventilatory support.
The SAFE approach
S – Shout for help
A – Approach with care
F – Free from danger
E – Evaluate the patient.
• On discovering or being asked to attend to a collapsed patient, the first response must be to shout for help
• BLS techniques are more effective if performed by two rescuers
• Rescuers should approach a collapsed person with care, never putting themselves or others at risk
• If there are risks either to the victim or rescuer, then the patient must be moved to a place of greater safety which is free from danger before starting resuscitation. This decision will inevitably result in a delay to instituting BLS
• Finally, the rescuer must evaluate the patient’s airway, breathing and circulation. Not all collapsed patients will need artificial ventilation and external cardiac compressions.
Patient evaluation
Check the patient for a response: place one hand on the patient’s forehead and shake the shoulder gently with the other hand. At the same time, ask loudly, ‘Are you all right?’
The patient responds by either talking or moving:
• If it is safe to do so, leave the patient in the position in which he or she was found and summon medical assistance or prepare for transfer. Regular reassessment is mandatory
• The head is held stable during the evaluation to guard against the possibility of aggravating an injury to the cervical spine and where there is obvious trauma, the cervical spine must then be immobilised by manual in-line stabilisation
• The patient may be deaf, therefore ensure he or she can see your lips moving when assessing responsiveness.
There is no response to voice or touch:
• If no assistance has arrived, shout for help again and then turn the patient onto their back in a controlled manner. BLS cannot be performed on a patient who is prone or lying awkwardly
• Evaluate the state of the patient’s airway, breathing and circulation.
Open the airway
• In most unconscious patients, the reduced tone in the muscles of the tongue, jaw and neck allow the tongue to fall against the posterior pharyngeal wall
• If a foreign body in the airway is suspected, then the procedure for the choking patient should be followed
• The following manoeuvres are designed to achieve a clear airway.
Head tilt plus chin lift
• This manoeuvre is not recommended if there is any possibility that the patient has a cervical spine injury
• The rescuer’s hand nearest the head is placed on the forehead, gently tilting (extending) the head backwards as though the patient is sniffing
• The chin is then lifted using the index and middle finger of the rescuer’s other hand. If this causes the mouth to close, the lower lip should be retracted downwards by the thumb
• This is the ‘triple airway manoeuvre’ – head tilt, chin lift, mouth open.
Jaw thrust
• If there is a suspicion that the cervical spine may have been injured, then the jaw thrust alone is used
• The patient’s jaw is thrust upwards (forwards) by applying pressure behind the angles of the mandible
• The rescuer uses the fingers, with the base of the thumbs resting on the patient’s cheeks
• When performed correctly, this manoeuvre is uncomfortable for the patient and is generally not tolerated if the patient is conscious.
Patients with suspected cervical spine injury
• Great care should be taken with airway alignment in patients with suspected cervical spine injury. Flexion and rotation of the neck are the most dangerous movements. At all times manual in-line stabilisation should be applied by an assistant
• The safest way to achieve airway patency in patients with suspected cervical spine injury is by jaw thrust
• Extension of the head on the neck should be minimised to that just necessary to establish an airway. It is important to remember, however, that airway obstruction is immediately lethal and airway management takes precedence.
Assess breathing
Keep the airway patent while now assessing breathing for no longer than 10 seconds:
• Look down the line of the chest to see if it is rising and falling
• Listen at the mouth and nose for breath sounds, gurgling or snoring sounds
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| Figure 5.1. |
| Head tilt, chin lift. |
• Feel for breathing at the patient’s mouth and nose with the side of your cheek.
The professional medical responder may check the carotid pulse at the same time. Agonal gasps are present in 40% of cardiac arrest patients and must not be misdiagnosed as normal breathing.
The patient is breathing
• Place the patient in the recovery position unless it is unsafe to do so because of other injuries
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