Once safety in the environment is established, the healthcare professional should call for help and perform the shake-and-shout procedure. Once colleagues are available to help, a number of actions can be undertaken in the initial phase of managing an arrest.
Breathing and pulse check
• You should observe for signs of breathing and for circulation.
• In some cases it is recommended that these checks are made simultaneously.
If the breathing and pulse are present:
• summon emergency medical support;
• start to administer oxygen;
• attach ECG monitoring leads and commence monitoring;
• secure venous access if this is not already in place.
If breathing and pulse are absent members of the team should initiate the following.
• Summon the cardiac arrest team immediately using the local emergency number.
• Ensure resuscitation equipment and the defibrillator are accessible at the patient's side.
• Support the airway and ventilation using available equipment, such as a pocket mask, oropharyngeal airway, LMA or bag-valve-mask (see Chapter 7 for further explanation of this equipment).
• Ensure oxygen is delivered at a tidal volume of 400-600 ml to reduce gastric inflation.
• Proceed in delivering two ventilations and 15 chest compressions until the patient is intubated with a secure cuffed tracheal tube or LMA.
• As a priority, the electrodes of either a manual or automated external defibrillator (AED) should be attached to the patient and used as necessary (see Chapter 9 for further explanation).
• Intravenous access should be secured, if not already available.
• You should prepare to hand over to the arriving cardiac arrest team, providing access to the patient's notes.
• If the patient's relatives or other patients are in the vicinity, ensure members of the nursing team are available to provide appropriate support.
The recovery position is vital in maintaining support of the airway, as it ensures the tongue is held in a forward position and it reduces the chance of inhalation of any expelled gastric contents (Resuscitation Council UK 2000a).
Whilst placing a casualty in the recovery position, make sure you maintain your own good posture and prevent injuries to yourself and the casualty.
• Make sure the environment is safe; check for potential hazards such as broken glass.
• Remove any hazards from the casualty, such as work tools or spectacles.
• Kneel next to the casualty.
• Ensure the casualty has straight legs and is lying on their back.
• Move the arm closest to you so that it is at right angles to the casualty's body, with the palm of the hand facing upwards.
• The other arm should be positioned across the chest, with the back of the hand placed next to the casualty's cheek. The hand should be held in this position.
• The leg furthest away from you should be bent at the knee, ensuring the foot is in contact with the ground.
• Pull on the leg, whilst maintaining hold of the hand on the cheek, to roll the casualty towards you onto their side.
• Move the upper leg to ensure it is at right angles to the casualty, supporting a stable position.
• Ensure the airway is open, tilting the head back if necessary and using the hand to support the positioning of the head (see Figures 5.5a-d and Box 5.1).
Box 5.1 Best practice - monitoring the casualty in the recovery position
Frequently check breathing rate and depth.
Observe the circulation to the lower arm that the casualty is lying on.
Turn the casualty onto their opposite side if they are required to remain in the recovery position for more than 30 minutes.
Preserve dignity throughout.
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