Basic life support - Assessment and Resuscitation Procedures

Emergency Response: Assessment and Cardiopulmonary Resuscitation Introduction When faced with an emergency medical situation, the ability to act quickly and correctly can mean the difference between life and death. The process of responding to cardiac emergencies follows a systematic approach: first assessing the scene and patient, then initiating appropriate resuscitation techniques if needed. Understanding this sequence and executing it properly is the foundation of emergency response. Assessment and Initial Steps Scene Safety First The very first action in any emergency is to assess the scene for danger. Before you help anyone, you must ensure that you and the victim are safe from hazards. This principle is critical because an injured rescuer cannot help the victim, and may become a second patient that emergency services must treat. Common scene hazards include: Electrocution risks (downed power lines, electrical equipment) Traffic or assault (dangerous environments) Drowning hazards (water or unstable surfaces) Fire or burning (extreme heat or flames) If dangers are present, you must remove yourself and the victim from the hazard before providing care. Only once the scene is safe should you proceed to assess the patient. Assessing Level of Consciousness Once the scene is safe, quickly determine whether the patient is conscious and alert. The AVPU scale provides a rapid framework for this assessment: Alert: The patient is awake and aware of their surroundings Verbal: The patient responds to verbal stimuli (voice commands or questions) Pain: The patient responds only to pain stimuli Unconscious: The patient does not respond to any stimuli When assessing responsiveness to pain, use caution and appropriate techniques. Central pain stimuli (applied to the body's core) include the trapezius squeeze, where you pinch the muscle between the neck and shoulder. Peripheral pain stimuli (applied to the extremities) include squeezing the side of a finger. These techniques should be firm enough to elicit a response, but not cause unnecessary harm. If a patient responds only to pain or is unconscious, they require immediate emergency intervention. Opening the Airway An unconscious patient's airway can become blocked, preventing oxygen from reaching the lungs. To prevent this, you must open the airway using the proper technique. The jaw-thrust maneuver is the preferred method. Place your hands on either side of the patient's jaw and gently push it forward without tilting the head backward. This keeps the airway open while minimizing movement of the neck and spine—a critical concern if spinal injury is suspected. Avoid the head-tilt maneuver (tilting the forehead back) in emergency settings, as this can worsen a spinal injury if one is present. The jaw-thrust maneuver safely opens the airway without this risk. If aspiration (inhaling stomach contents) is a concern, place the patient in the recovery position—lying on their side with the head tilted back slightly—which allows fluids to drain from the mouth rather than into the lungs. Assessing Breathing Check whether the patient is breathing normally. Look for chest rise, listen for breath sounds, and feel for air movement. This assessment should take only a few seconds. If breathing normally: Place the patient in the recovery position and call emergency medical services immediately. Continue monitoring for changes. If not breathing or breathing abnormally: Proceed to circulation assessment and prepare for chest compressions. Assessing Circulation and Beginning Compressions If the patient is unresponsive and not breathing normally, assume cardiac arrest and begin chest compressions immediately. Do not delay to check for a pulse—modern protocols prioritize starting compressions quickly. Continue chest compressions until one of the following occurs: An automated external defibrillator (AED) is available and applied Signs of return of spontaneous circulation appear (patient begins breathing, coughing, or moving) Professional emergency medical personnel arrive and take over Cardiopulmonary Resuscitation Technique Compression Rate and Depth The effectiveness of CPR depends on performing compressions at the correct rate and depth. For adults, compress the chest at a rate of one compression per second, which is approximately 60 compressions per minute. This rate is fast enough to maintain circulation without being so rapid that compressions become ineffective. For children and infants, use the same rate of approximately 60 compressions per minute, but apply less force. The technique adjusts to the patient's size while maintaining the critical rhythm. A helpful way to remember the rate is to think of the beat of the song "Stayin' Alive"—the rhythm matches the recommended compression rate. Compression-to-Ventilation Ratio Most adults in cardiac arrest have sufficient oxygen in their blood from their last breaths; the priority is maintaining circulation through compressions. Therefore, rescuers must balance chest compressions with rescue breaths (ventilations). The standard adult ratio is 30 compressions followed by 2 rescue breaths. This means: Perform 30 chest compressions at the proper rate Give 2 rescue breaths (or use a barrier device if available) Immediately resume compressions Repeat this cycle continuously For infants and children, when two rescuers are present, the ratio may be 15 compressions to 2 breaths, which allows more frequent ventilation since children's hearts are often healthier and cardiac arrest may be due to breathing problems rather than heart rhythm abnormalities. Compression-Only CPR Not all rescuers are trained in or comfortable giving rescue breaths. In such cases, compression-only CPR is an acceptable option for adults. This means performing continuous chest compressions without pausing for rescue breaths. Compression-only CPR is effective for up to approximately five minutes. After five minutes, if rescue breaths have not been initiated, the patient's oxygen levels may become critically depleted, making full CPR with ventilations necessary. Using the Automated External Defibrillator The automated external defibrillator (AED) is a critical tool in cardiac emergencies. When an AED becomes available: Complete the current round of compressions before stopping Apply the defibrillator pads to the patient's bare chest as instructed by the device Follow the device's prompts exactly—the AED analyzes the heart rhythm and provides instructions The AED will advise one of three actions: Shock advised: A shock is needed to restore normal heart rhythm. Ensure no one is touching the patient, then deliver the shock. No shock advised: Continue CPR Resume compressions: After delivering a shock, begin compressions again Post-Defibrillation Care After the AED delivers a shock, immediately resume chest compressions. The shock alone does not guarantee the heart will beat on its own; compressions maintain circulation. Continue compressions for another two minutes before stopping to re-analyze the heart rhythm with the AED. This cycle—2 minutes of compressions followed by rhythm analysis—repeats until one of the following occurs: Non-shockable rhythm detected (such as asystole, which is complete absence of heart activity, or normal sinus rhythm with a pulse): Stop CPR and assess for signs of life. If the patient shows no response, professional medical personnel may continue supportive care. Shockable rhythm detected: Deliver another shock and resume compressions Professional help arrives: Transfer care to emergency medical personnel The key principle is that CPR is continued in cycles of compression and analysis until the patient shows clear signs of recovery or professional medical help takes over.