1. Danger

Check for potential dangers to yourself, colleagues, and the patient.

Ensure adequate PPE[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]

2. Response

Assess the patient’s responsiveness using AVPU (Alert, Verbal, Pain, Unresponsiveness/Unconscious)

Patients unresponsive to verbal and tactile stimuli should indicate the continuation of basic life support.

3. Send for Help

Universal hospital emergency number: 222 or 2222

• Currently being adopted in ACT, NSW, & VIC
• Check local emergency number for health site

Refer to local guidelines regarding sending for help.

Once you have sent for help, continue basic life support[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]

Methods:

1. Verbal: Shouting that you need urgent assistance will generally bring staff members in the vicinity
2. Most hospital ward rooms will have a medical emergency button which will bring local/ward-based assistance
3. A Code Blue (medical emergency) should be called as soon as possible to ensure more specialised medical staff as well as resuscitation equipment and medications arrive promptly
   1. Note: Closed loop communication/confirming a task is done is essential to ensure that specialised assistance is on the way

4. Airway

Assess airway patency: eg. Oropharyngeal swelling indicating possible anaphylaxis or snoring indicating partial airway obstruction

Finding	Intervention
Non-patent airway	Airway maneuvers +/- Airway adjuncts
Foreign body causing obstruction	Remove via suction1
Dentures	Loose dentures: Remove1 Fitted dentures: Maintain in situ1Maintains facial structure aiding bag-mask ventilation1
Swollen oropharynx	Anaphylaxis pathway

Airway maneuvers:

• Head tilt and chin lift[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]:
  • Extend the patient’s head by placing a hand on the patient’s forehead whilst gently raising the patient’s chin with the other hand
  • Contraindication: Cervical or thoracic trauma
• Jaw thrust[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]: Push the jaw forwards by placing two fingers each side of the patient’s jaw with the thumbs opposing on the cheeks/chin

Airway Adjuncts and Devices

• Guedel/Oropharyngeal airway (OPA) 
• Nasopharyngeal airway (NPA) 
• Laryngeal mask airway (LMA) 
• Endotracheal tube (ETT)

5. Breathing

Assess the patient’s breathing:

• Look and feel for chest/abdominal rise and fall
• Listen and feel for breathing at the nose/mouth
• Attach pulse oximetry if available

If the patient is not breathing adequately, continue basic life support and commence cardiopulmonary resuscitation (CPR).

If the patient is breathing adequately, place in the recovery position and continue assessment.

6. Cardiopulmonary Resuscitation (CPR)

Adult cardiopulmonary resuscitation consists of cycling through 30 compressions followed by 2 breaths.

Compressions:

• Position: Lower half of sternum[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
• 1/3^rd depth of patient’s chest[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
• Rate: 100-120bpm[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
  • To the beat of “Staying Alive” or “Another One Bites the Dust” 
• Compressions should only pause for breaths, pulse checks, defibrillation, or for procedures such as endotracheal intubation¹
• Rotate responder administering compressions every 2 minutes to avoid fatigue¹

Breathing:

• Ventilation:
  • Bag-mask ventilation (BMV) +/- airway adjuncts
  • Laryngeal mask airway (LMA) ventilation
  • Endotracheal tube (ETT) ventilation
• Compressions can continue during ventilation if a definitive airway (eg. ETT) is in place

7. Defibrillator (AED)

• Pad placement:
  • Anterior-lateral positions[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
  • Do not place pads over:
    • ECG electrodes or leads[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
    • Medication patches[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
    • Implanted devices: eg. Pacemaker[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
    • Central line[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
• Prior to defibrillation
  • Ensure that all flammable gases/materials are clear (eg. Oxygen from ventilation)[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
  • Visually and verbally ensure everyone is clear of the patient[mfn referencenumber=1]Department of Health & Human Services. Standard 9 Basic Life Support learning Module (Recognising and Responding to Clinical Deterioration in Acute Healthcare). Victoria: State of Victoria; 2014[/mfn]
• Defibrillator settings (for manual defibrillators): 200 Joules for Adults