(Pre-Hospital) Adult Basic Life Support

UNRESPONSIVE

Shout for help and AED, Call 997/911

look for breathing effort.

NOT BREATHING NORMALLY? Or gasping breath

30 CHEST COMPRESSIONS

Open airway (Look, listen, and feel). Give 2 rescue breaths (if HCP or trained
layperson)
Only 30 chest compressions (if untrained rescuer)
In case of Pandemic stick only to Chest compression

Continue the cycle of 30

compressions: 2 breaths (rate 100-120/m)
Until EMS arrives or unable to proceed

Page | 1
Page | 2
 In Hospital Resuscitation
Collapsed /Sick patient.

Shout for HELP & assess patient / call for defibrillator.

Signs of life?

NO Yes
Call resuscitation team Assess ABCDE.
Recognize & treat Oxygen, monitoring, iv access!

CPR 30:2
with oxygen and airway adjuncts
Call resuscitation team If appropriate
Or Rapid response team (RRT)
Apply pads/monitor Attempt defibrillation If
appropriate.

Handover to resuscitation team or RRT

Advanced life Support when resuscitation team
arrives.
Page | 3
 pediatric Basic Life Support

Unresponsive?

Shout for help

Open airway

Look, listen, feel (if HCP or trained layperson)

Not breathing normally?
No signs of life?

2 rescue breaths (In case of Pandemic stick only to Chest compression)

Check pulse if HCP/trained lay person
30 chest compressions
(if two rescuers the compression: ventilation 15:2)

Call cardiac arrest team or Pediatric ALS team

Page | 4
 ADULT & Child FOREIGN BODY AIRWAY OBSTRUCTION
TREATMENT

Assess severity

Severe airway obstruction Mild airway obstruction

(ineffective cough) (effective cough)

Encourage cough.
Unconscious Conscious Continue to check for deterioration to
ineffective cough or until obstruction
relieved

Abdominal
Start CPR thrusts
repeatedly
(Heimlich maneuver)
Page | 5
 INFANT FOREIGN BODY AIRWAY OBSTRUCTION TREATMENT

Assess severity

Severe airway obstruction Mild airway obstruction

(ineffective cough) (effective cough)

Encourage cough
Unconscious Conscious
Continue to check for deterioration to
ineffective cough or until obstruction
Pediatric BLS sequence
relieved

Open airway Heimlich maneuver

2 breaths (5 back slaps then 5 chest thrusts for
infant)
Start CPR
(abdominal thrust for child > 1 year)

Page | 6
 Automated External Defibrillation
Algorithm

Unresponsive?

Look for breathing effort Not breathing normally/or gasping breath

Call 997 /911 and AED

Check pulse if HCP/Trained lay person

CPR 30:2 Until AED is attached (COVID-19 precautions)

AED ASSESSES RHYTHM

Shock advised No shock advised

1 Shock

Immediately resume: Immediately resume:

CPR 30:2 for 2 min CPR 30:2 for 2 min

Continue until:
• The victim starts to wake up: to
move, open eyes and to breathe
normally.
• EMS/Code team arrives.
Page | 7
 Advanced Life Support
UNRESPONSIVE?
NOT BREATHING OR ONLY OCCASIONAL GASPS

CALL RESUSCITATION TEAM

CPR 30:2
ATTACH AED OR DEFIBRILLATOR PADS/MONITOR MINIMIZE INTERRUPTIONS

ASSESSES RHYTHM

SHOCKABLE RETURN OF SPONTANEOUS NO SHOCK

(VF /PULSELESS VT) CIRCULATION DVISED

Immediate post cardiac arrest

treatment
1 SHOCK - use ABCDE approach
- controlled oxygenation and ventilation
- 12 lead ECG
- treat precipitating cause
- temperature control (TTM)

IMMEDIATELY RESUME: IMMEDIATELY RESUME:

CPR 30:2 FOR 2 MIN CPR 30:2 FOR 2 MIN
MINIMIZE INTERRUPTIONS MINIMIZE INTERRUPTIONS

DURING CPR REVERSIBLE CAUSES

• Ensure high-quality CPR: rate, depth, recoil. • Hypoxia
• Plan actions before interrupting CPR. • Hypovolemia
• Give oxygen. • Hypo- / hyperkalemia / metabolic
acidosis.
• Consider advanced airway and capnography.
• Hypothermia.
• Continuous chest compressions when advanced airway in
• Thrombosis - coronary or pulmonary.
place
• Tamponade – cardiac.
• Vascular access IV or IO. • Toxins.
• Give epinephrine every 3-5 min. • Tension pneumothorax.
• Amiodarone 300mg IV bolus for refractory VF/pulseless VT.
• In case of refractory VF or Pulseless VT a sequence of drug-
shock-drug should be followed every 3-5min.
• Correct reversible causes.

Page | 8
 Tachycardia Algorithm (with pulse)
Assess using the ABCDE approach.
Ensure oxygen given and obtain IV access.
Monitor ECG, BP, Sp02, record 12 lead ECG.
Identify and treat reversible causes (e.g., electrolyte abnormalities)

Synchronized DC Shock* Assess for evidence of instability signs: Shock,

One attempt Instable Stable Is QRS narrow (< 0.12 sec)?
Syncope, Myocardial ischemia, Heart failure…

Amiodarone 300 mg IV over 10-20

min and repeat shock; followed by:
Broad Narrow
Amiodarone 900 mg over 24

Narrow QRS
Broad QRS Regular Irregular
is QRS regular?
Is QRS regular?
• Use vagal maneuvers Irregular narrow complex tachycardia
• Adenosine 6 mg rapid IV bolus; Probable atrial fibrillation Control rate
with:
• If unsuccessful give 12mg;
Seek expert help B-Blocker or diltiazem
• If unsuccessful give further 12mg.
Consider digoxin or amiodarone If
• Monitor ECG continuously
evidence of heart failure
Anticoagulate If duration > 48h

Normal sinus rhythm restored? No Seek expert help

Possibilities Include: If Ventricular Tachycardia:
• AF with bundle branch block treat as for • Amiodarone 300 mg IV over 20-60 min; Yes
narrow complex then 900 mg over 24 h
• Pre-excited AF consider amiodarone If previously confirmed Possible atrial flutter Control
• Polymorphic VT (e.g. torsades de pointes- SVT with bundle branch block or (uncertain Probable re-entry PSVT: rate (e.g. B-Blocker)
give magnesium sulphate 2g over 10 min monomorphic rhythm): • Record 12·lead ECG in sinus rhythm
• Give adenosine as for regular narrow • If recurs, give adenosine again &.
complex tachycardia consider choice of antiarrhythmic
prophylaxis
*Attempted electrical cardioversion is always undertaken under sedation or anesthesia
Page | 9
 Bradycardia Algorithm
Assess using the ABCDE approach.
Ensure oxygen given and obtain IV access.
Monitor ECG, BP, Sp02, record 12 lead ECG
Identify and treat reversible causes (e.g., electrolyte abnormalities)

Assess for evidence of instability signs :

1. Shock
Yes 2. Syncope No
3. Myocardial ischemia
4. Heart failure

Atropine
0.5 – 1 mg IV

Risk of asystole?
Satisfactory response? Yes
-Recent asystole
-Mobitz 2 AV block
No -Complete heart block with broad QRS
-Ventricular pause > 3s
Yes

Interim measure:
• Atropine 0.5 - 1 mcg IV
• repeat to maximum of 4 mg No
• epinephrine 2-10 mcg/min
• Alternative drugs *
OR
• Dopamine/dobutamine infusion
• Isoprenaline 5 mcg/min
• (alternative to transcutaneous pacing Observe

Seek Expert help

Arrange transvenous pacing

* Alternative drugs include:

• Dopamine
• Glucagon (if beta-blocker or calcium
channel blocker overdose)

Page | 10
 Pediatric Advanced Life Support

Unresponsive?
Not breathing or only occasional gasps

HIGH QUALITY CPR Call Resuscitation

Attach defibrillator/ monitor Minimize interruptions. Team
(2 min CPR first. if alone)

ASSESSES RYTHM

Shockable Return of Spontaneous

(VF /Pulseless VT Circulation No shock advised
(PEA/Asystole)

Immediate Post Cardiac Arrest

1-Shock 2-4J/Kg
Immediately resume:
CPR for 2 min
Minimize interruptions
Epinephrine 0.01mg/kg
Treatment
- Use ABCDE approach
- Controlled Oxygenation and Immediately resume:
ventilation
- Investigations
CPR for 2 min
- Treat precipitating cause Minimize interruptions
- Temperature control Epinephrine 0.01mg/kg
(TTM)

DURING CPR REVERSIBLE CAUSES

• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolemia
• Give oxygen • Hypo- / hyperkalemia / metabolic acidosis
• Consider advanced airway and capnography • Hypothermia
• Continuous chest compressions when advanced airway In • Thrombosis - coronary or pulmonary
place • Tamponade - cardiac
• Vascular access IV, IO • Toxins
• Give epinephrine every 3-5 min • Tension pneumothorax
• Amiodarone 5 mg/Kg IV bolus for refractory VF/pulseless VT
• Consider alternative anti arrhythmic drugs for resistant
VF/pVT
• Correct reversible causes

Page | 11
 NEWBORN LIFE SUPPORT

Dry the baby Birth

Remove any wet towels and cover Start the clock or note the time

30 sec

Assess (tone), breathing and heart rate

60 sec

If gasping or not breathing Open the airway

Give 2 inflation breaths, Consider Sp02 monitoring Acceptable*
pre-dudalSp02

2 min:60%
Re-assess If no increase in heart rate Look for chest 3 min :70%
4 min:80%
movement. 5 min :85%
10 min:90%

If chest not moving Recheck head position, Consider two-person

airway control or other airway maneuvers Repeat inflation breaths
Consider Sp02 monitoring Look for a response

If no increase in heart rate Look for chest movement

When the chest is moving If the heart rate is not detectable or slow (< 60)
Start chest compressions with 2 thumbs=encircling hands technique
fifteen compressions to two breath (15:2)

Reassess heart rate every 30 seconds If the heart rate is not

detectable or slow (< 60) Consider venous access and drugs

Page | 12
CPR PRACTICAL CHECK LIST
Terminology
BLS Basic Life Support
CPR Cardiopulmonary Resuscitation = Cardiac compression and breathing
FBO Foreign Body Obstruction
PALs Pediatric Advance Life support
NALs Neonatal Advance life support
AED Automated External Defibrillation
ABC Airway Breathing Circulation
CAB Chest compression Airway Breathing

BLS PRACTICAL STATIONS

1. Call for Help.
• Pre-hospital (Out of Hospital Cardiac Arrest (OHCA)): call 997
• In hospital:
- Paging system
- bleep system
- Unannounced
2. PRE-HOSPITAL
2.1. ADULT CPR (Pre-hospital → CAB)
A. Establish unresponsiveness and check for effort of breathing by opening the airway (3-
5 sec.) EMS system should be activated (997) and get the AED
B. No effort of breathing start CAB sequence.
C. check pulse (if trained < 5 sec) and immediate chest compression 30 Compressions
within the first 10-15 seconds (rescue compression). Open airway (head tilt-chin lift).
D. Check for breathing (look, listen, feel). If breathing is absent or inadequate, give 2
breaths,” rescue breathing” 1 second per breath (3 sec.), Healthcare providers should
use a barrier device while lay persons can use any other means to protect themselves,
e.g. Shamagh, Ghuthra, Shayla, handkerchief or towel. Watch chest rise and fall during
exhalation.
E. CPR Sequence.
1. Locate and check carotid pulse or femoral pulse (5-10 sec.). If pulse is present but no
breathing, provide rescue breathing (one breath every 5-6 seconds, about 10 -12 breaths
per minute).
2. If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2 minutes)
with ratio 30:2 and at a rate of at least 100-120 per minute. Minimal interruption during
compressions (<10 seconds), Chest compression (approximately 4.5-5.5cm depth/ or 5 cm
= 2 inches. not more than 6 cm) followed by 2 breaths (1 second/breath). The set of each
30 compressions should take approximately 15-18 seconds.
3. After 5 cycles of CPR (Approximately 2 minutes) compression: ventilation ratio 30:2 and
at a rate of at least 100-120 per minute.)
check for pulse in carotid or femoral arteries. According to the findings:

Page | 13
 ▪ If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected, monitor Vital signs until EMS arrives.
▪ If there is pulse but no breathing. Continue rescue breathing, one breath every 5 – 6 sec.
(10 - 12/min.), Recheck pulse every 2 minutes.
▪ If there is no pulse, no breathing. Continue CPR, 5 cycles of CPR (Approximately 2 minutes)
as mentioned above. Then check pulse in carotid or femoral arteries every 2 minutes).
Continue the cycles until success is achieved or EMS arrived.

if RESCUER 2 arrives; Rescuer 1 stays as the ventilator and rescuer 2 acts as the chest
compressor; Rescuers should switch every 5 cycles of CPR approximately 2 minutes.

2.2. PRE-HOSPITAL CHILD & INFANT CPR

A. Establish unresponsiveness and check for effort of breathing by opening the airway (3-5
sec.)
B. (EMS system should be activated (997) and get the AED if second rescuer around
otherwise start resuscitation then call after 2 minutes). No effort of breathing start ABC
sequence.
C. Open airway (head tilt-chin lift) Check breathing (look, listen, feel) (if trained 5-10 sec).
D. If breathing is present place the victim carefully in recovery position, then check pulse (if
trained A, B, C the same sequence no change). If untrained apply (C-A-B) sequence with
immediate chest compression 30 rescue compressions and 2 rescue breathing.
E. Healthcare providers should use a barrier device while lay persons can use any other
means of protecting themselves, e.g. Shamagh, Ghuthra, shayla, handkerchief or towel.
Watch chest rise and fall during exhalation.
F. CPR SEQUENCE:
1. Locate and check carotid pulse or femoral pulse (5-10 sec.) and brachial in case of
infant. If pulse is present but no breathing, provide rescue breathing (one breath every
4-5 seconds, about 12 -20 breaths per minute).
2. If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2
minutes) with ratio 30:2 and at a rate of at least 100-120 per minute. Minimal
interruption during compressions (<10 seconds), Chest compression (approximately 4-
5cm depth/ or 4 cm = 1.5 inches. not more than 5 cm) followed by 2 breaths (1
second/breath). The set of each 30 compressions should take approximately 15-18
seconds.
3. After 5 cycles of CPR (Approximately 2 minutes) compression: ventilation ratio 30:2
and at a rate of at least 100-120 per minute.).
check for pulse in carotid or femoral arteries. According to the findings:
◼ If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected, monitor Vital signs until EMS arrives.
◼ If there is pulse but no breathing. Continue rescue breathing, one breath every 3 –
5 sec. (12 -20/min.), Recheck pulse every 2 minutes.
◼ If there is no pulse, no breathing. Continue CPR, 5 cycles of CPR (Approximately 2
minutes) as mentioned in step 5. Then check pulse in carotid or femoral
arteries/brachial for infant every 2 minutes). Continue the cycles until success is
achieved or EMS arrives.

Page | 14
 if RESCUER 2 arrives; Rescuer 1 stays as the ventilator and rescuer 2 acts as the chest
compressor; with a ratio of 15:2; Rescuers should switch every 5 cycles of CPR approximately
2 minutes.

3. IN HOSPITAL
3.1. ADULT CPR
A. Establish unresponsiveness and check for effort of breathing by opening the airway (3-5 sec.),
in hospital EMS system should be activated and get crash cart and the AED (2015 guidelines
preferred PAD system instead of paddles ones. Start ABC sequence.
B. Check for breathing (look, listen, feel). If breathing is absent or inadequate, give 2 breaths,
“rescue breathing” (1 second per breath (3 sec.), Healthcare providers should use a barrier
device preferred Bag Valve mask resuscitator. Watch chest rise and fall during exhalation.
C. CPR SEQUENCE:
1. Locate and check carotid pulse or femoral pulse (5-10 sec.). If pulse is present but no
breathing, provide rescue breathing (one breath every 5-6 seconds, about 10 -12 breaths
per minute).
2. If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2 minutes)
with ratio 30:2 and at a rate of at least 100-120 per minute. Minimal interruption during
compressions (<10 seconds), Chest compression (approximately 4.5-5.5cm depth/ or 5 cm
= 2 inches. not more than 6 cm) followed by 2 breaths (1 second/breath). The set of each
30 compressions should take approximately 15-18 seconds.
3. After 5 cycles of CPR (Approximately 2 minutes) compression: ventilation ratio 30:2 and
at a rate of at least 100-120 per minute.).

check for pulse in carotid or femoral arteries. According to the findings:

◼ If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected, monitor Vital signs until EMS arrives.
◼ If there is pulse but no breathing. Continue rescue breathing, one breath every 5 – 6 sec.
(10 - 12/min.), Recheck pulse every 2 minutes.
◼ If there is no pulse, no breathing. Continue CPR, 5 cycles of CPR (Approximately 2 minutes)
as mentioned in step 5. Then check pulse in carotid or femoral arteries every 2 minutes).
Continue the cycles until success is achieved or EMS arrives.

if RESCUER 2 arrives; Rescuer 1 stays as the ventilator and rescuer 2 acts as the chest
compressor; Rescuers should switch every 5 cycles of CPR approximately 2 minutes.

3.2. IN HOSPITAL CHILD & infant CPR

A. Establish unresponsiveness and check for effort of breathing by opening the airway (3-5
sec.), in hospital EMS system should be activated and get crash cart and the AED (2015
guidelines preferred PAD system instead of paddles ones. Start ABC sequence.
B. Check for breathing (look, listen, feel). If breathing is absent or inadequate, give 2 breaths,
“rescue breathing” (1 second per breath (3 sec.), Healthcare providers should use a barrier
device preferred Bag Valve mask resuscitator. Watch chest rise and fall during exhalation.
C. CPR SEQUENCE:

Page | 15
 1. Locate and check carotid pulse or femoral pulse/ brachial for infant (5-10 sec.). If pulse
is present but no breathing, provide rescue breathing (one breath every 5-6 seconds,
about 12 -20 breaths per minute).
2. If no pulse, start compression: ventilation cycles. Give 5 cycles (Approximately 2
minutes) with ratio 30:2 and at a rate of at least 100-120 per minute. Minimal
interruption during compressions (<10 seconds), Chest compression (approximately 4-
5cm depth/ or 4 cm = 1.5 inches. not more than 5 cm) followed by 2 breaths (1
second/breath). The set of each 30 compressions should take approximately 15-18
seconds.
3. After 5 cycles of CPR (Approximately 2 minutes) compression: ventilation ratio 30:2
and at a rate of at least 100-120 per minute.),

check for pulse in carotid or femoral arteries. According to the findings:

◼ If there is pulse and breathing: Place the victim in the recovery position carefully,
especially if neck injury is suspected, monitor Vital signs until EMS arrives.
◼ If there is pulse but no breathing. Continue rescue breathing, one breath every 3 – 5 sec.
(12 -20/min.), Recheck pulse every 2 minutes.
◼ If there is no pulse, no breathing. Continue CPR, 5 cycles of CPR (Approximately 2
minutes) as mentioned in step 5. Then check pulse in carotid or femoral arteries /
brachial for infant every 2 minutes). Continue the cycles until success is achieved or EMS
arrives.

if RESCUER 2 arrives; Rescuer 1 stays as the ventilator and rescuer 2 acts as the chest
compressor; with a ratio of 15:2; Rescuers should switch every 5 cycles of CPR approximately
2 minutes.

4. FBO
4.1. FBO (PARTIAL):
In case of FBO with partial obstruction in all age group only encourage the victim to cough or
expel the FB, you may help with back blows.
how to recognize partial obstruction.
- conscious
- no cyanosis
- severe coughing
- no stridor

4.2. FBO (SEVERE):

in case of FBO with severe obstruction in all age group you must intervene as per age group skills
and maneuver to help the victim expel the FB.
how to recognize severe obstruction.
- conscious
- cyanosis
- severe coughing
- stridor
4.2.1. SEVERE FBO IN ADULT & CHILDREN
Page | 16
 4.2.1.1. CONSCIOUS:
Ask “Are you choking?” If the patient nods " yes" and uses the universal sign of choking,
immediately intervene by:
1. Stand behind the victim and give Abdominal Thrusts (Heimlich maneuver), aiming
to increase the intrathoracic pressure and expel the foreign body.
2. NOTE: Use Chest thrusts for pregnant or obese victim
3. Repeat thrusts with a distinctive movement to achieve expulsion of the foreign
body or the victim becomes unconscious.

4.2.1.2. Victim becomes unconscious (witnessed)

1. Put the victim in the ground and activate the EMS system or send someone to activate.
(997 for prehospital)
2. Observe for breathing normality or absence, if breathing is absent or inadequate, open
the airway and try to ventilate. If unsuccessful, re-open the airway and try to ventilate
again. If still unsuccessful begin cycles of chest compression and ventilation with the
ratio 30:2.
3. Every time the airway is opened to give breaths, open the mouth wide and look for
the object. If you see an object removes it using finger sweep. Then try to ventilate, if
unsuccessful, re-open the airway and try to ventilate again, if still unsuccessful begin
cycles of chest compression and ventilation with the ratio 30:2.
4. Repeat steps till chest raise, if chest raised, check pulse and continue 5 cycles of CPR
about 2 minutes.
5. Repeat cycles and reassess the pulse every 2 minutes (5 cycles).
According to findings:
◼ If there is pulse and breathing: Place the victim in the recovery position
carefully, especially if neck injury is suspected. Monitor Vital signs until EMS
arrives.
◼ If there is pulse but no breathing. Continue rescue breathing, one breath every
5 – 6 sec. (10 - 12/min.)
◼ If there is no pulse and no breathing. Continue maneuvers of adult CPR.

4.2.1.3. Victim found unconscious (unwitnessed)

Establish unresponsiveness and effort of breathing by opening the airway (3-5 sec.) EMS
system should be activated (997 for prehospital) and get the AED
Start CPR sequence according to the age group

4.2.2. SEVERE FBO IN INFANT

4.2.2.1. conscious:
Confirm airway obstruction. Check for serious breathing difficulty, ineffective cough,
weak or absent cry.
1. Give up to 5 back blows, turn the infant carefully using both hands supporting the
face and the back of the head and give 5 chest Thrusts.
2. Repeat blows and thrusts until achievement of expulsion of the foreign body or the
victim becomes unconscious.

Page | 17
 4.2.2.2. Victim becomes unconscious (witnessed)
1. Put the victim in the ground and activate the EMS system after 2 minutes or send
someone to activate. (997 for prehospital)
2. Observe for breathing normality or absence, if breathing is absent or inadequate, open
the airway and try to ventilate. If unsuccessful, re-open the airway and try to ventilate
again. If still unsuccessful begin cycles of chest compression and ventilation with the
ratio 30:2.
3. Every time the airway is opened to give breaths, open the mouth wide and look for
the object. If you see an object removes it using finger sweep ( do not sweep blindly)
Then try to ventilate, If unsuccessful, re-open the airway and try to ventilate again, If
still unsuccessful begin cycles of chest compression and ventilation with the ratio 30:2.
4. Repeat steps till chest raise, if chest raised, check pulse and continue 5 cycles of CPR
about 2 minutes.
5. Repeat cycles and reassess the pulse every 2 minutes (5 cycles)
According to findings:
◼ If there is pulse and breathing: Place the victim in the recovery position
carefully, especially if neck injury is suspected. Monitor Vital signs until EMS
arrives.
◼ If there is pulse but no breathing. Continue rescue breathing, one breath every
3 – 5 sec. (12 - 20/min.)
◼ If there is no pulse and no breathing. Continue maneuvers of infant CPR.

4.2.2.3. Victim found unconscious (unwitnessed)

1. Establish unresponsiveness and effort of breathing by opening the airway (3-5 sec.)
EMS system should be activated after 2 minutes (997 for prehospital) and get the AED.
2. Start sequence of infant CPR.

5. AED (AUTOMATED EXTERNAL DEFIBRILLATION)

1. Establish unresponsiveness and check for effort of breathing by opening the airway (3-5 sec.),
in hospital EMS system should be activated and get crash cart and the AED (2015 guidelines
preferred PAD system instead of paddles ones).
2. Check for breathing (look, listen, feel). If breathing is absent or inadequate, give 2 breaths,
“rescue breathing” (1 second per breath (3 sec.), Healthcare providers should use a barrier
device preferred Bag Valve mask resuscitator. Watch chest rise and fall during exhalation.
3. Locate and check pulse (5-10 sec.). If pulse is present but no breathing, provide rescue
breathing as per age group.
4. Attach the AED as soon as it arrived.
5. Place the AED next to the victim. POWER ON the AED
6. Attach electrode pads in the proper positions (as pictured on each of the AED electrodes,
sternum, and apex, with proper contact and no overlap of pads).
NOTE: CPR should not be interrupted during this procedure.
7. Clear the victim during the ANALYZE. Some machines may ask you to press the analysis
button, others will analyze automatically. The AED may take 5-15 seconds for analysis. (AED
advises shock and charges)
8. Clear before delivering the shock. Ensure no contact with the victim. Loudly announce “I am
clear, you are clear, all are clear “or simply “clear”, then press the shock button. Single shock
Page | 18
 only to be delivered and then every 2 minutes thereafter. IN between start CPR 5 cycles of
chest compression: ventilation as per age group. CPR is applied as 1-man CPR, while the
second rescuer only operates the AED.
9. Repeat these steps until the EMS or ACLS team arrive or until the AED shows “No Shock
Indicated”.

Continue monitoring the vital signs every two minutes and according to the findings:
• If there is pulse and breathing: Place in the recovery position carefully, especially if neck injury
is suspected, monitor Vital signs & ECG.
• If there is pulse but no breathing. Continue rescue breathing, (1 breath every 5 – 6 sec. (10 –
12/min.) for adult or one breath / 3 – 5 sec. (12 – 20 min.) for child and infant).
• If there is no pulse and breathing: Continue CPR 5 cycles of CPR (approx. 2 minutes)
compression: ventilation 30:2 ratio and at a rate of least 100-120 per minute. Minimal
interruption in compressions. Chest compressions depth according to the age of the victim,
then analyze, shock, CPR and so on until success is achieved or EMS arrives.

6. BARRIER DEVICE.
6.1. FACE SHIELD:
It is transparent sheet, with a permeable piece of cloth to allow ventilation through. It has a
marking for the rescuer to know his side “this side up”. It shows if any secretion or moist of
breathing. If not available a piece of cloth (like SHOMAGH or SHAYLA) will do.
6.2. POCKET MASK:
It is a face mask that fit for adult and children. it is transparent to show secretions or moist
of breath. It has a p it is foldable and fit in a box, so to be carried. it can have an oxygen inlet
for increasing the oxygen content of the rescuer breath.
6.3. BAG-VALVE-MASK:
It is a manual secured ventilation system. It consists of mask, one-way valve and bag to deliver
air. It delivers up to 100% oxygen. It is used by trained health care provider. Skills for how to
use it and securing the mask on the face by C-E technique should be emphasized during the
practical training.

Page | 19
 CPR FORM
HOSPITAL: ________________ REGION: ________________
DATE: ________________ NAME: ________________
DIAGNOSIS: ________________ HOSPITAL NO: ________________
CONSULTANT: ________________ WARD: ________________

Report Directions:
Complete all sections of this form for each resuscitation effort
Forward to CPR Coordinator through Nursing Supervisor by the end of shift

CARDIAC ARREST Section 1: (Circle where appropriate)

Arrest Discovered by: ________________ Category: ________ Time: ___________
Resuscitation Started by: ________________ Category: ________ Time: ___________
Resuscitation Ended by Dr.: ________________ Category: ________ Time: ___________
Code Call Placed by: ________________ Category: ________ Time: ___________
DNR ordered by: ________________ Category: ________ Why: ___________

PRE-ARREST STATE (Circle where appropriate) Section 2: (Circle where appropriate)

Cardiac Monitor: ⬜Y ⬜N E/t Tube in situ: ⬜Y ⬜N
Mechanical Ventilation: ⬜Y ⬜N IV in situ: ⬜Y ⬜N
Type of Fluid: ⬜Y ⬜N Others: ⬜Y ⬜N

ADVANCED CARDIAC LIFE

(Circle where appropriate) Section 3: (Circle where appropriate)
SUPPORT
Sinus Rhythm: ⬜Y ⬜N Type of Dysrhythmia:
Defibrillation without therapy: ⬜Y ⬜N

Monophasic Biphasic Type of Arrest

1. 200 200 Joules -Time: ______ A) Cardiac ⬜Y ⬜N
2. 200/300 200 Joules -Time: ______ B) Respiratory ⬜Y ⬜N
3. 360 200 Joules- Time: ______ C) Other causes: ⬜Y ⬜N

Description of Procedure Dose and time

Shock 360/200 Joules ______ ______ ______
Cardioversion 50/100/150 J. ______ ______ ______
I.V. Line / IO line ______ ______ ______
Intubation ______ ______ ______
Adrenaline ______ ______ ______
Atropine ______ ______ ______
Amiodarone ______ ______ ______
Lignocaine ______ ______ ______
Valium ______ ______ ______
NaHCO3 ______ ______ ______
Calcium ______ ______ ______
Total Volume IV Fluid ______ ______ ______
Pacemaker ______ ______ ______
Procainamide ______ ______ ______
Magnesium Sulphate ______ ______ ______
Others ______ ______ ______

CODE RESPONSE Section 4: (Circle where appropriate)

Consultant (Anesthetist, medical,
⬜Y ⬜N Anesthesia Technician ⬜Y ⬜N
pedia, obst)

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 Registrar/Resident (Anesthetist,
⬜Y ⬜N Head Nurse ⬜Y ⬜N
medical, pedia, obst)
Nurse Supervisor ⬜Y ⬜N Pharmacist ⬜Y ⬜N

RESUSCITATION REPORT Section 5: Must be signed by the charter

Problems: A) Supply:
B) Equipment:
C) Others
Follow-up:
Outcome:

Report completed by Nurse-in-charge or Patient Nurse:

Name: Signature:

NURSE’S REPORT Section 6: Must be signed by the head nurse

Code Call Nurse’s Report:
Comments:

Name: Signature:

DOCTOR’S REPORT/COMMENTS Section 7: Must be signed by the leader

Name: Signature:

RESUSCITATION RESULT Section 8: Must be signed by the head nurse

Successful: ⬜Y ⬜N If YES. Transferred to Ward/Unit (__________________)
24 Hours Survival ⬜Y ⬜N
Discharged from Hospital ⬜Y ⬜N Date: ____-____-_____ Time:
If Unsuccessful: Date: ____-____-_____ Time:
Death Certified by Dr:

Signature of CPR Coordinator:

The chart must be collected by the team leader of the code Procedure immediately and delivered
to the CPR committee.

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 Adult Observation sheet for Early Warning Score (Vital Signs)

EWS Key (3-2-1-0) Patient Name: MRN: Age: Admission Date

Date

Time

Respiratory Rate ≥25

19-24

12-18

10-11

≤8

SpO2 ≥96

94-95

93-91

≤90

On O2 supply %

Temperature ≥39

38

37

36

≤35

≥200

Blood Pressure EWS 190

uses Systolic BP
180

170

160

150

140

130

120

110

100

90

80

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 70

60

≤50

Heart Rate ≥140

130

120

110

100

90

80

70

60

50

≤40

Alert

V/P/U

Total Early Warning Score (EWS)

The above result will not be calculated as EWS; however, it may help to give a bigger picture about patient condition.

Blood sugar

Pain score

Urine output 30 ml\hr. Yes / NO

Assessment done by

Action

EWS Monitoring Alert / inform Review

Score 0 As required

Score 1-2 12 Hourly If concern

Check in 1 hour, then document:

• Observation frequency
Score 3-5 4-6 Hourly Nurse in charge • Fluid balance?
• Sepsis?
• Criteria for escalation

• Nurse in charge
Score 6-8 SICK! 1-2 Hourly Within 30 minutes, concern, or ICU Consultation
• Physician (resident)

• Nurse in charge
9+ Immediate ACTIVE RRT
30 Minutes • Physician (resident) Within 15 minutes SBAR Consultant & ICU?
NOW!
• Specialist& consultant

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Page | 24