# Basic Life Support- Adult

## Overview

This module describes how to resuscitate an adult patient in cardiac arrest using a simple algorithmic approach.

## Indications

1. Unresponsive patient

## Contraindications

1. None for the assessing the patient, but whether to proceed with resuscitation may be subject to patient consent directives

## Patient information & consent

In unresponsive patients, consent is generally implied.

“Do Not Resuscitate”

“Do Not Resuscitate”

DNR orders may be initiated:

1. where a patient has made an advance directive (e.g. a ‘living will’) or makes an informed decision to refuse CPR
2. when clinical judgement concludes that CPR is futile (patient is dying from some other irreversible condition)
3. when after discussions with the patient and/or his or her family an agreement is reached that the benefits of CPR are outweighed by the burdens and risks involved.

(DNR) orders, “Not For Max” orders, or living wills that specify that no resuscitation may be performed take precedence.

## Preparation

Basic Life Support is an emergency procedure. Always:

1. If outside the hospital, carry gloves and a CPR protective device you can use in an emergency.
2. In public places such as airports and malls, look out for AEDs and first aid stations attached to walls.
3. Memorise emergency phone numbers, or keep them on your cell phone, so you can call for help.
4. In the hospital, be aware of where the defibrillators and red trolleys are kept. Know the staff in the department. Keep your seniors’ contact details close at hand.
5. Keep unstable patients in resuscitation bays with continuous monitoring.

## Site & Positioning

The patient should be lying flat on their back on a

firm surface

firm surface

If on a soft bed, ask for a resuscitation board.

. There should be space behind the head of the bed for staff to stand. Staff performing chest compressions should stand on a step or kneel on the bed.

## Procedure

Use medical asepsis with non-sterile gloves.

1. Hazards: Check that the scene is safe for you and the patient; look for any body fluid spills, trip hazards, and put on gloves. Follow Transmission-Based Precautions as required.

2. Hello: Tap the patient’s shoulder and shout “Hello/Are you okay!”. Look for a

   response
   response

   If the patient responds, stop the BLS algorithm.

   .

3. Help: If unresponsive, shout for nearby help.

   - In hospital: alert other healthcare providers or activate the emergency response system.
   - Prehospital: activate Emergency Medical Services (“CPR in progress”), and send someone to direct the ambulance on arrival.
   - If alone, get the AED/Defibrillator and emergency equipment. If someone else is available, send them to get it.

4. Assess for 10 sec by simultaneously feeling the pulse and checking for breathing

   - Breathing: with ear close to mouth, scan the victim’s chest for rise and fall
   - Pulse: Palpate the carotid pulse on the side closest to you for at least 5 but no more than 10 sec.

5. If the patient is

   - breathing normally and has a pulse: place in recovery position and monitor until help arrives.
   - not breathing normally but has a pulse: provide rescue breaths at 1 assisted breath every 6 sec with basic airway manoeuvers.
   - not breathing and has no pulse: immediately start CPR.

6. If proceeding with CPR:

   - Give 30 chest compressions at a rate of almost 2 compressions/sec, or 100-120 compressions/min. Minimise interruptions.
   - Open the airway using a head-tilt chin-lift or jaw thrust.
   - Provide rescue breaths 1/sec looking for chest rise.

7. Repeat step 6 until the defibrillator or AED arrives and follow the algorithm:

   - If shock advised or defibrillation indicated: deliver shock and resume CPR immediately after defibrillation.
   - If no shock advised, resume CPR.

8. Continue 30:2 CPR in cycles of 2 min or until prompted by AED to check rhythm. Continue until signs of life are present, or until your senior declares death.

## Troubleshooting

I don’t have a CPR protective device for mouth-to-mouth breaths.

Give hands-only CPR (continuous compressions without breaths) until equipment such as a BVM resuscitator arrives.

I’m unsure about the quality of my chest compressions.

Check the following:

1. Centre compressions on the lower half of the sternum, compressing ⅓ of the depth of the chest.
2. Ensure good chest recoil (don’t lean on the chest between compressions).
3. Your shoulders should be directly above your hands, elbows straight.
4. Stand on a step or kneel on the bed so that your hips are higher than the patient’s chest.
5. Minimise interruptions.
6. Change chest compressors every 2 min to avoid fatigue.

I’m unsure about the quality of my rescue breaths.

Ensure correct head position. Consider using an oropharyngeal or nasopharyngeal airway. Ensure that you are pulling the face into the mask using an EC grip, rather than leaning on the patient’s face. Continuously monitor chest rise.

My patient is moving but I still can’t find a pulse.

Patients in cardiac arrest may have movements such as twitching or writhing. If there is no pulse and the patient is not responding to your prompts, continue CPR.

I heard something crack under my hands.

Rib and sternal fractures are not uncommon. Continue CPR, but ensure your hand placement is correct.

## Risks

1. Unsuccessful CPR
2. Bruising
3. Rib/sternal fractures
4. Pneumothorax
5. Defibrillator burns
6. Healthcare worker exposure to infectious substances

## References

1. Resuscitation Council of Southern Africa. Basic Life Support Algorithm. 2021.
2. McQuoid-Mason DJ. Emergency medical treatment and 'do not resuscitate' orders: when can they be used?. S Afr Med J. 2013;103(4):223-225. Published 2013 Jan 23. doi:10.7196/samj.6672