Adult BLS and AED:

Made sure that I, victim and bystanders were safe?

Gently shook shoulders of patient and asked loudly: ‘Are you alright?’

As unresponsive shouted for help?

Assessed airways by turning patient onto their back, tilting head and lifting chin?

As this did not work or trauma suspected applied jaw thrust technique?

Looked, listened and felt for normal breathing for no more than 10 seconds?

As unresponsive and not breathing called 999 (as alone and no mobile phone available commenced BLS for 1 min. and then went and summoned help)?

Sent for an AED?

Started 30 chest compression with below technique?

- In the centre of the chest

- Straight arms

- 5-6 cm depth (without leaning on the chest, allowed it to recall)

- 100-120 compression per minute

- Changed CPR provider every 2 minutes to prevent fatigue

Gave 2 rescue breaths with below technique?

- Steady and normal breath into the patient mouth (or nose or tracheostomy) over second

- No interruption of chest compressions for more than 10 seconds

As untrained, unable or unwilling to provide rescue breaths, continued chest compressions only?

As soon as AED arrived:

- Switched it on and follow instructions, but minimise the interruptions to CPR?

- Attach electrodes onto the bare chest?

- As more than one rescuer, continue CPR whilst pads are attached?

- Followed instructions, ensured no one is touching the patient, when the shock was delivered?

Continued CPR 30 chest compressions: 2 rescue breaths until help arrived and did not stop CPR?

Covid-19 infection?

As chest compressions aerosol generating used (ideally) full (level 3) PPE (Resus UK 2021)?

Did not put my face near the patients to listen/feel for breath?

As level 3 PPE was not available individual decisions made on course of action depending on risks?

Chest compressions undertaken as a minimum with below technique?

- Level 2 PEE (eye protection, gloves, apron and fluid resistant face mask)

- Covered the patient’s nose and mouth with cloth/mask

Ventilations with bag valve mask only as level 3 PPE available?

Attached defibrillator ASAP?

Adult ALS:

Oxygen given?

Waveform capnography used?

IO or IV access established?

Adrenaline given every 3-5 minutes (first dose as soon as access is secured)?

Amiodarone given after 3 shocks?

Reversible causes treated:

4 Hs: Hypoxia, Hypovolaemia, Hyper/Hypokalaemia/metabolic changes,

Hypothermia

4 Ts: Thrombosis (coronary or pulmonary), Tension pneumothorax, Tamponade (cardiac), Toxins

Post resuscitation care:

Maintained SpO2 94-98%?

Advanced airway?

Waveform capnography?

Ventilated lungs to normocapnia?

12-lead ECG?

Obtained reliable intravenous access?

Aimed for SBP > 100 mmHg?

Restored normovolaemia with crystalloid fluids?

Monitored intra-arterial blood pressure?

Considered vasopressor/inotrope to maintain SBP?

Ensured constant temperature 32-36°C?

Sedated?

Controlled shivering?

Likely cardiac cause?

If not, considered CT brain and/or CPTA?

If yes, ST elevation on 12 lead ECG?

If yes, coronary angiography +/- PCI?

If no, considered coronary angiography +/- PCI?

Acknowledged the below?

Survival from out of hospital cardiac arrest in the UK 7-8%, in some countries 25-30%

Early defibrillation: for every minute defibrillation is delayed survival falls by 10%

Clinical Frailty Score (CFS) = 5+: unlikely to benefit/survive

5: Mildly Frail – These people often have more evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications).

Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework

Resource(s):

Resuscitation Council UK: Adult basic life support Guidelines

Resuscitation Council UK: Adult advanced life support Guidelines