Safety

❌ Ensure it is safe for you to approach the patient

❌ Put protective equipment on quickly

❌ Be mindful when using sharps

Assess the patient for a response

❗Shake them and ask if they can hear you❓

❗If they respond, ensure they receive immediate medical attention (ABCDE approach)

If the patient does not respond

❗Shout for help 🗣

Inspect airway:

❗Ensure the patient is positioned on their back and open their airway:

1. Put one hand on their forehead and one beneath their chin
2. Lift the chin up and tilt the head back
3. Inspect airways for obstruction
4. If the airway if obstructed, try to use suction or your finger to sweep it out

Assess for signs of life:

❗Jaw thrust: used in place of the head-tilt and chin-lift when spinal injury is suspected, to prevent the tongue obstructing the airway

• Use 2 hands to displace the lower jaw forwards and upwards

❗Carotid pulse: performed simultaneously with the jaw thrust 💓

• Check for a carotid pulse on the neck

❗Breathing: listen, look and feel for breathing for 10 seconds 💓

• Visible movement of chest
• Air blowing against your face
• Audible breathing
• Other signs of life such as movement

Agonal Breathing:

❗This is NOT a sign of life as it is when the patient is irregularly gasping for breath 🌬

Pulse present, but low respiratory rate:

❗Respiration rate <12: use the bag valve mask to maintain 10 breaths per minute 💓

Pulse present, and acceptable respiratory rate:

❗Further medical attention is required to maintain this stability

No signs of life

Call the ‘crash team’:

❗To resuscitate the patient with CPR

❗Call 2222 in a hospital (state location and whether it is an adult or paediatric patient)

Perform chest compressions:

❗With the patient on a hard, flat surface, perform 30 chest compressions then 2 ventilations and repeat

1. Place your hands, one on top of the other in the centre of the lower part of the sternum
2. Compress the chest by 1/3 of the depth of chest wall
3. Deliver the compressions at a rate of 100-120 compressions per minute with no interruptions
4. Ensure the chest fully recoils
5. Every 2 minutes alternate the person performing the compressions
6. Following tracheal interruption (if performed), continue compressions

Ventilate patient:

1. Tilt the head and lift the chin
2. Pinch the nostrils closed 👃
3. Position your mouth over the patient’s
4. Breath into their mouth twice and check for chest rising 👄
5. Remove your fingers from the nostrils as they exhale the air
6. Administer 30 compressions to the chest
7. Ensure the patient receives additional oxygen as soon as possible

❗In clinical settings, mouth to mouth ventilation is not performed as alternative equipment is available which will not put the patient or clinician at risk of infection 👄

Defibrillation:

1. Attach the automated external defibrillator (AED) to the patient’s chest:

         ❗Adhesive Pad 1: below the clavicle, to the right of the sternum

         ❗Adhesive Pad 2: on the mis-axillary line

         ❗You may need to shave any hair and should remove piercings

    2. Turn the AED on and follow the instructions, for example:

         ❗Pause chest compressions

         ❗Deliver a shock if the rhythm is shockable and the patient is not in contact with anyone else

         ❗Continue CPR following the shock and follow any additional instructions

Signs of life identified

Organise urgent medical assessment!

❗Assess ‘ABCDE’:

A: Airway: ensure it is unobstructed

B: Breathing: deliver supplementary oxygen and monitor SpO₂ 🌬

C: Circulation: check the patient’s blood pressure, attach ECG monitoring and gain venous access

D: Disability: check the capillary blood glucose levels and assess AVPU/GCS

E: Exposure: inspect the patient to identify trauma or pathology

Handover to the medical team

Summary:

1. Assess the patient for a response
2. If they do not respond: inspect airways, assess for signs of life, identify agonal breathing, assess for presence of pulse and respiratory rate
3. If there are no signs of life: call the crash team, perform chest compressions, ventilate the patient and perform defibrillation
4. If signs of life are identified: organise urgent medical assessment (ABCDE)
5. Handover to the medical team