sternum at least one‐third the depth of the chest (5–6 cm). Ensure that pressure is released after each compression and that you don't lean on the chest wall, allowing recoil.2 Your partner is continuing chest compressions and the neighbour will assist them. You are positioned at the head of the patient. What actions will you take next?By positioning yourself at the head of the patient you are in an ideal position to manage the airway. First check the airway for any obstructions, suction the saliva out of the patient’s mouth and check for any foreign bodies. Next an oropharyngeal (OP) tube needs to be correctly sized to the patient and inserted. The sizing is important, as inappropriate size will be ineffective and can be detrimental to the patient by not sitting in the correct position and causing trauma. Size the airway by measuring from the middle of the front teeth to the angle of the jaw.
3 After an oropharyngeal (OP) tube has been inserted, what ratio of compressions to ventilations will be used?The ratio is 30 : 2. Perform 30 compressions to every 2 ventilations, with compressions at a rate of 100–120 per minute.
4 How often should the person performing compressions change over?The person performing compressions should be changed every 2 minutes to prevent fatigue and ensure that good‐quality compressions are been delivered.
Case Progression
Your partner and the neighbour are delivering good‐quality compressions and swapping every 2 minutes. You have inserted an OP tube and you are delivering 2 breaths after pausing briefly (2 breaths in 1 second) following every 30 compressions. You have completed your rhythm checks every 2 minutes, delivering 1 shock when the patient was in VT, but now on your last rhythm check the patient was in asystole. You have completed 6 minutes of basic life support (BLS).
Patient assessment triangle
General appearance
The patient is unresponsive.
Circulation to the skin
Grey in colour.
Work of breathing
Nil
SYSTEMATIC APPROACH
Danger
Nil.
Response
None.
Airway
Clear, pale.
Breathing
Nil.
Circulation
Asystole, 0 heart rate.
Disability
As stated previously.
1 You have completed 6 minutes of BLS and another crew arrive to assist. The patient is now is asystole and you are completing rhythm checks every 2 minutes. What other interventions could now be considered?An advanced airway can now be inserted: a supraglottic airway device (SAD) can be correctly sized and inserted to ensure effective ventilations. Once this is inserted and confirmed in position, compressions can become continuous and the patient can be ventilated at a rate of 6–10 bpm (approx. 1 every 6 seconds).An IV line can be inserted, or an intra‐osseous (IO) infusion if your skill set allows, with adrenaline administration commenced.
LEVEL 1 CASE STUDY
Acute coronary syndrome (ACS)
| Information type | Data |
| Time of origin | 10:00 |
| Time of dispatch | 10:01 |
| On‐scene time | 10:06 |
| Weather | 21 °C, blue skies |
| Nearest hospital | 10 minutes |
| Nearest backup | CCP, 15 minutes |
| Patient details | Name: Georgia Perry DOB: 14/02/1941 |
CASE
You have been dispatched code 1 to the residence of a 79‐year‐old female who has had an onset of chest pain while gardening.
Pre‐arrival information
The female is conscious and breathing, and states she developed central chest and abdominal pain while gardening.
Windscreen report
The house is low set and appears to have neat gardens, nil signs of any danger. The patient is sat under a tree with a lawn mower nearby and you can see that it has been turned off.
Entering the property
You are met at your vehicle by the patient’s neighbour, who is concerned as he witnessed the patient mowing her lawn and then suddenly stop and appear to hold her chest. He immediately ran to her assistance and sat her on a chair, where she is located now. The lawn mower is turned off and there are no dangers in the garden.
On arrival with the patient
The female patient is sitting on a chair, holding her chest. She is alert to your presence and orientated to time and place. There are no obvious injuries or major haemorrhage.
Patient assessment triangle
General appearance
The patient appears in mild distress, pink in colour, alert to your presence and speaking in full sentences.
Circulation to the skin
Well perfused, mildly pink to her face and sweaty, but it is a warm day.
Work of breathing
Occasional sighing.
SYSTEMATIC APPROACH
Danger
Nil.
