Chapter Three – Resuscitation
Resuscitation – the preservation or restoration of life by establishing and maintaining a person’s airway,
breathing and circulation.
Remember – with an unconscious patient ANY attempt at resuscitation is better than nothing.
All body tissues require oxygen. Most important is the brain.
OH&S Note – we will be working with manikins – please make sure that you are familiar with the cleaning
and disinfection procedures.
Chain of Survival
Early Access – identify, reach and remove patient to a safe location ASAP. Contact emergency services
through Surfcom or 000 immediately.
Early CPR – commence CPR ASAP.
Early Defibrillation – introduce defib unit ASAP.
Early Advanced Life Support – ambulance, trained medical staff, emergency ward ASAP.
DRABCD
DANGER – ensure no danger to SELF, BYSTANDERS, PATIENT
RESPONSE – check for response by talk & touch.
“COWS”
Can you hear me?
Open your eyes.
What’s your name?
Squeeze my hands
Never shake an unconscious patient – why ?
AIRWAY – roll onto side, check and clear airway. Check for signs of life. Movement, responsiveness,
conciousness, breathing. If patient has not been immersed you may assess patient’s airway while they are on
their back.
BREATHING – Look, listen feel. If NOT breathing tilt head backward and give 2 breaths.
COMPRESSION – If no signs of life present give 30 compressions and 2 breaths – 5 cycles in 2 minutes.
DEFIBRILLATION – Attach a defib unit ASAP. Switch on and follow voice prompts.
Patient Assessment
Positioning the Unconcious Patient
Normally working with patients who have been immersed. Positioning for drainage is important.
1. Locate patient above waterline on dry sand
2. Try and position in true lateral position
3. Stable position
4. Avoid pressure on chest that could impair breathing
5. Should be possible to go from back to side taking care for suspected spinal injury
6. Should be possible to see / clear airway
7. Position should not give rise to any injury
Patient Face Down
1. Kneel beside patient
2. Place arm alongside patient
3. Use hip & shoulder roll to get patient onto side
4. Recovery position with head supported
Patient Face Up
1. One arm at right angles
2. Other arm across chest
3. Lift right leg
4. Use hip and shoulder roll to get patient on side
5. Recovery position with head supported
For larger patients put one arm under patients raised knee and grip other leg.
Checking and Clearing Airway
Note: key to a successful resuscitation is a clear airway
Check & remove any physical debris with fingers.
Backward Head Tilt
Chin Lift = Jaw Support (Pistol Grip) or Jaw Thrust
Types of Rescue Breathing
Mouth to Mask – recommended. Masks should be carried at all times.
Mouth to Mouth – if no mask or suitable mask available. Seal patients mouth with own mouth. Seal
patients nose with pinch. Blow until you see chest rise. Allow air to leave and tilt head to side to
watch chest fall and listen to air coming out of patient. Look for swelling / distension of the stomach.
Why ?
Mouth to Nose – use in deep water, CPR of infants when you can cover mouth & nose, if jaw
damaged or tightly clenched, where preferred. Mouth must be sealed during inflation. Same rules as
for Mouth to Mouth.
Compressions
Position yourself alongside patient.
Place hands on lower half of the patient’s sternum – centre of the chest.
Place heel of one hand at this point – fingers parallel to ribs other hand around the wrist.
Force must be vertical – central – sufficient to get ~1/3 depth
Arms should be straight and rescuers weight used to achieve the compressions
As few interruptions as possible
What are you doing ?
Heart is rhythmically compressed between the sternum and the backbone.
Rate:
2 breaths – 4 seconds
30 compressions – 20 seconds
1 Cycle = 24 seconds
5 Cycles = 2 minutes
Cardiopulmonary Resuscitation = CPR = Rescue Breathing + External Chest Compression (ECC)
- artificial ventilation of the lungs
- artificial circulation of the blood
How Long do you Continue ?
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Patient recovers breathing & signs of life
Someone else takes over or patient moves to ambulance / doctor
Rescuer cannot physically continue
Authorized person pronounces life extinct
CPR is only suspended for:
Defib
Rescue breaths
Two person CPR
Key – good communications
1 person – summon help – defib – oxygen
Other – DRABCD
Rotate roles where possible
Recovery Position – Lateral Position
Keep watch on patient
 Clear airway
 Signs of life
 Protection from heat / cold / sun
 Handle gently
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Reassure
Leave defib pads on
Refer to hospital (via ambulance rescue service)
Protect patients privacy & dignity
Ensure any transfers are smooth
Complications
Blocked Airway – check head tilt and jaw lift, check for foreign material, check seal is firm, enough air is
being blown
Vomiting – active / muscular process where stomach ejects contents – loud noise – maybe some warning.
Regurgitating – silent flow of stomach contents into mouth and nose. May be due to swallowing lots of
water or over inflation (inflating stomach).
Vomiting & Regurgitation – roll onto side immediately – drain / clear mouth – check airway and continue
DRABCD.
Distension of stomach (abnormal swelling)
Caused by swallowing of water / air while in trouble.