Basic life support and first aid (CPR, AED, airway, bleeding, shock)
Basic life support and first aid test the interventions that keep a patient alive until definitive care: CPR, defibrillation, airway management, bleeding control, and shock management.
Core rules
- Check response, breathing, and pulse for no more than 10 seconds. Agonal gasps are not normal breathing.
- Compressions: centre of the chest, 100 to 120 per minute, 5 to 6 cm deep in adults, 4 to 5 cm in children, about 4 cm in infants, with full recoil and minimal interruption.
- Ratio: 30 compressions to 2 breaths for a single rescuer in adults, children, and infants; 15 to 2 for two rescuers with children and infants. Change compressor every 2 minutes.
- AED: power on, attach pads to a bare dry chest, clear everyone during analysis and shock, shock if advised, and resume compressions immediately.
- Airway: head-tilt chin-lift for most patients, jaw thrust when spinal injury is suspected. Size oropharyngeal and nasopharyngeal airways against the patient, and ventilate with a bag-valve mask using a two-person technique when possible.
- Severe bleeding: direct pressure, then wound packing with gauze or a haemostatic dressing for deep wounds, then a commercial tourniquet 5 to 7 cm above the wound, not over a joint, with the time recorded. Do not loosen it.
- Shock: lay the patient flat, keep them warm, control bleeding, give nothing by mouth, and monitor.
Worked example
An adult collapses in a training hall; an AED is on the wall. Reasoning: check response, breathing, and pulse in under 10 seconds; start compressions at 100 to 120 per minute; send a second person for the AED and emergency services; apply pads, clear, shock if advised, and resume compressions at once; continue 30:2 until the patient breathes normally or care is handed over.
Traps
- Checking the pulse for a minute while compressions are delayed.
- Stopping compressions to search for a pulse every cycle.
- Applying AED pads over a wet chest or a medication patch without preparing the skin.
- Loosening or removing a tourniquet because the limb looks pale.
- Giving food or drink to a patient in shock.