WAJD Learning

Module 12 of 15 · 50 minutes

Standard 12: Basic life support

By the end of this module you will be able to

  • Perform the initial assessment sequence safely
  • Describe adult CPR to current Resuscitation Council UK guidance
  • Use an automated external defibrillator correctly
  • Explain DNACPR and ReSPECT, and what they do and do not mean

Amara Before we start, be honest with me. Can I learn CPR from an audio course?

Nadia No. And I want that said clearly at the top rather than buried at the end. You can learn the sequence, and understanding it genuinely matters. But compression depth, rate, hand position and opening an airway have to be practised on a manikin and assessed by an instructor.

Amara So what is this module for?

Nadia So that when you attend the practical session you already know what you are doing and why, and so that you can walk into an emergency with a sequence in your head instead of panic. Book the practical. Repeat it annually. And if you ever see a provider selling an online only basic life support certificate, no employer should accept it.

Amara Right. Take me through the adult sequence.

Nadia Danger first. Is the area safe for you. And I mean that seriously, because a second casualty helps nobody. Then response: shake the shoulders, shout, are you all right. Shout for help early, earlier than feels natural.

Amara Then airway.

Nadia Head tilt, chin lift. Then breathing: look, listen and feel for no more than ten seconds. And here is the thing I most want you to take away from this whole module.

Amara Go on.

Nadia Agonal gasping is not breathing. In the first minutes of a cardiac arrest, people often make irregular, noisy, gasping sounds. It looks like breathing to somebody frightened, and it is the single commonest reason bystanders do not start CPR on somebody who could have survived.

Amara So if I see gasping?

Nadia Treat it as cardiac arrest. Call 999, phone on speaker, send someone for an AED, and start compressions.

Amara Give me the numbers.

Nadia Centre of the chest, heel of the hand. Five to six centimetres deep. A hundred to a hundred and twenty per minute. Let the chest come all the way back up between compressions, because filling matters as much as squeezing. Thirty compressions to two rescue breaths if you are trained and willing.

Amara And if I am not willing? Being honest, with a stranger, I might not be.

Nadia Then do compression only CPR, and do not feel a moment's guilt about it. Compression only is vastly better than nothing, and hesitating over breaths is worse than skipping them.

Amara The defibrillator terrifies people. What if I shock somebody who does not need it?

Nadia You cannot. The machine analyses the rhythm and will not deliver a shock unless one is indicated. Switch it on and it talks you through it, in plain English, written for people with no training at all.

Amara Anything practical to know?

Nadia Pads on bare dry skin as pictured. Do not touch the person while it analyses or shocks. Go straight back to compressions after a shock, do not wait to see what happens. Take off any medicine patches, keep the pad off a pacemaker lump, and only shave chest hair if the pads genuinely will not stick.

Amara Choking. Quickly.

Nadia If the cough is ineffective: five back blows between the shoulder blades, then five abdominal thrusts, and alternate. If they go unresponsive, start CPR. And anyone who has had abdominal thrusts needs medical assessment afterwards, even if they seem fine.

Amara Last thing, and it comes up constantly. DNACPR.

Nadia A DNACPR means one thing. Cardiopulmonary resuscitation will not be attempted if the heart stops. It means nothing else at all.

Amara But I have seen it treated as meaning do not bother.

Nadia So have I, and it kills people. A DNACPR does not mean withhold antibiotics. Or food. Or fluids. Or pain relief. Or hospital admission. Somebody with a DNACPR who develops a chest infection gets treated for a chest infection.

Amara And ReSPECT?

Nadia A broader form that records recommendations for emergency treatment overall, of which resuscitation status is only one part. It is designed precisely to stop the do not bother problem.

Amara Who can put a DNACPR in place?

Nadia It is a clinical decision, and it must be discussed with the person, or with those close to them where the person lacks capacity. And it must never be applied on the basis of age, disability or learning disability alone. Blanket application is unlawful, and it was the subject of a national CQC review after exactly that happened at scale.

The written material

This module cannot certify you

Basic life support is a practical skill. Knowledge of the sequence is necessary and it is not sufficient. Chest compression depth and rate, hand position and airway opening have to be practised on a manikin and assessed by an instructor.

This module teaches the current sequence so that you understand what you are doing and why. You must also attend a practical session, and refresh it annually. Any provider selling an online only basic life support certificate is selling something no employer should accept.

The adult sequence

Danger. Check that the area is safe for you first. You are no use as a second casualty. Response: shake the shoulders and shout, are you all right. Shout for help early. Airway: head tilt, chin lift. Breathing: look, listen and feel for no more than ten seconds. Agonal gasping is not normal breathing, and it is the commonest reason bystanders fail to start CPR.

If not breathing normally, call 999, put the phone on speaker, and get an AED. Start chest compressions: centre of the chest, heel of the hand, 5 to 6 centimetres deep, at 100 to 120 per minute, allowing full recoil between compressions. If trained and willing, give 30 compressions to 2 rescue breaths. If not, compression only CPR is far better than nothing.

  • Rate 100 to 120 per minute, depth 5 to 6 centimetres in an adult
  • Minimise interruptions, and change rescuer roughly every two minutes if you can
  • Agonal gasps are a sign of cardiac arrest, not of breathing
  • Compression only CPR is appropriate if you are untrained or unwilling to give breaths

Defibrillation

Early defibrillation is the single biggest determinant of survival in a shockable rhythm. Every minute of delay reduces survival substantially. Switch the AED on and follow the spoken instructions: they are written for untrained users and are hard to get wrong.

Attach the pads to bare, dry skin as pictured. Do not touch the person while it analyses or shocks. Continue compressions immediately after a shock. Remove transdermal patches, avoid placing a pad directly over a pacemaker, and shave excessive chest hair only if it prevents the pads sticking.

Choking, recovery position, DNACPR and ReSPECT

For choking with an ineffective cough: 5 back blows between the shoulder blades, then 5 abdominal thrusts, alternating. If the person becomes unresponsive, start CPR. Anyone who has received abdominal thrusts needs medical assessment.

An unresponsive person who is breathing normally goes into the recovery position, with continual monitoring, because breathing can stop at any point.

A DNACPR decision means that cardiopulmonary resuscitation will not be attempted if the heart stops. It means nothing else. It does not mean withhold antibiotics, food, fluids, pain relief, hospital admission or any other treatment. ReSPECT is a broader form recording recommendations for emergency treatment, of which resuscitation status is one part.

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