Guidelines for resuscitation

Guidelines for resuscitation The process of resuscitation should only be attempted, following practice, if the practitioner is competent and confident. Practitioners must be familiar with the position and contents of the resuscitation trolley and the emergency number in the event of a cardiac arrest. They must also attend an annual resuscitation update session.

The following information represents the Resuscitation Council's most recent guidelines, which were last updated in 2005 and are current at the time of publication. Ensure that you are using the current version of the guidelines (the ratios of breaths to chest compressions may change) by checking on the Council's website: http://www.resus.org.uk

The collapsed adult patient in hospital

• On discovery of the patient, shout for help and assess the safety of the environment for potential hazards, such as water, trailing electrical cables, and obstruction of the patient area.• Assess the patient: is he or she breathing, does he or she have a carotid or central pulse, what is his or her skin colour?If there are no apparent signs of life:• Call the resuscitation team and start cardiopulmonary resuscitation (CPR). Ensure that the patient is positioned so that effective CPR can begin, using the head tilt/chin lift manoeuvre. Start cardiac compressions at the level just above the xiphoid process, at the rate of 30 compressions to 2 forced breaths to the lungs via the mouth. Observe the movement of the chest during the procedure.• Apply the defibrillation pads and attempt defibrillation if competent to do so, otherwise wait for the resuscitation team to arrive and take over the care. If there are signs of life:• Assess the patient's airway (note any obstruction), breathing (for the rate and depth of respiration), and circulation or pulse (for capillary refill time); check whether there is any evidence of disability assessing response to voice and pain.• Assess whether the patient requires any drugs or oxygen.• Ensure effective monitoring of the patient (to include glucose monitoring and vital signs) and hand over to the resuscitation team.There should be a debriefing session to review the process at a suitable time.

Paediatric basic life support

• On discovery of the child, shout for help and assess the safety of the environment for potential hazards, such as water, trailing electrical cables, and obstruction of the patient area.• Assess the child: is he or she breathing, does he or she have a carotid or brachial pulse, what is the skin colour?• Ensure that the airway is open by using the head tilt/chin lift manoeuvre. If the child is not breathing normally and there is no evidence of obstruction to the airway, perform 5 rescue (or forced) breaths to the lungs via the nose and mouth, depending on the size of the child. Observe the movement of the chest during the procedure.• If the child remains unresponsive, start cardiac compressions at the rate of 15 chest compressions, using fingers or one hand (depending on the size of the child) at the level of the nipples and to a depth of one third of the child's chest, and 2 rescue breaths for 1 minute, then call the resuscitation team. Continue until the team arrives.There should be a debriefing session to review the process at a suitable time.

Foreign body causing airway obstruction

• Carefully assess the severity of the obstruction taking care not to force the obstruction further down the upper airway.If the child has an effective cough:• Encourage deeper coughing.• Observe carefully for evidence of deterioration to ineffective coughing or relief of the obstruction, which will be demonstrated by a rapid change in the colour of the child.If the child has an ineffective cough and is unconscious:• Perform 5 rescue breaths and start chest compressions at the rate of 15 compressions to 2 rescue breaths.If the child has an ineffective cough and is conscious:• Perform either 5 sharp back blows or 5 abdominal thrusts, depending on the size of the child (children under the age of 12 months should not be subjected to abdominal thrusts); this should dislodge the obstruction.• The child will need careful continuing observation.