Basic life support


Summary of Key Points for OSCEs


This situation may arise in the OSCE as either an out-of-hospital or an in-hospital situation, but in any case, until help arrives, the basic life support (BLS) technique is the same. The ‘help’ awaited will either be the emergency medical services outside the hospital or the cardiac arrest team in hospital.


There will be a manikin on whom you will be asked to perform the technique. This may be a simulation station, in which the dummy will be able to talk, or you may be demonstrating on a lifeless (sometimes limbless) manikin. It is important to know what equipment your clinical skills centre has and to familiarise yourself with it, as it is highly likely that this will be what appears in the exam.


BLS sometimes occurs as part of another scenario in which you have been called to see a sick patient and they suddenly become unresponsive. This is why frequent reassessment of the patient in any such scenario is important. The moment there is any doubt, start checking for the patient’s response and begin BLS if necessary.


Note that, in the same station, BLS may then progress to advanced life support (ALS) when the necessary help arrives. ALS follows on from BLS, and is covered in the next station.


Hints and Tips for the Exam



  • You must learn the Resuscitation Council (UK) guidelines and follow them to the letter. This should easily secure you a pass in this station.
  • Always ensure your own safety first. Do not start BLS in the middle of a busy road for example, and ensure you have easy access to the patient without risking your own comfort.
  • The patient’s safety is paramount. Move the patient to a place of safety before you begin BLS.
  • The ideal patient position for BLS is supine. If the patient arrests in a chair, they should be gently laid down with help, and space cleared around them in order for the resuscitation team to be able to reach the patient.
  • Some situations require cervical spine immobilisation, which means that you must not carry out a head tilt in your airway manoeuvres. Cervical spine immobilisation is required in the following situations:

    • Known or suspected neck trauma
    • Drowning situations
    • Unknown or uncertain mechanism in cases of injury

  • In any such station, your very first step is to confirm cardiac arrest:

    • Check for a response by gently shaking/stimulating the patient, and shouting ‘Are you all right?’
    • Look, listen and feel for breathing for 10 seconds:

      • Open the airway with head tilt, chin lift, jaw thrust, as illustrated in Figure 68.2.


      • Place your face near the mouth, looking at the chest, and listen for sounds of breathing while feeling for warm breath on your cheek and observing the chest wall (Figure 68.3).

  • You should then shout for help.
  • If help arrives, they should be instructed to contact 999 or the cardiac arrest team:

    • The communication here must be clear.
    • It must be emphasised that the patient is not breathing, is unresponsive or has arrested, and your location must be clearly described.
    • If no help is available, you must call for help yourself prior to commencing BLS.

  • As always, take an ABC approach.
  • When you open the airway, check for things that may obstruct the airway, for example blood, vomit, loose teeth or poor-fitting dentures. Turn the head to one side and scoop any obstructions out with your finger:

    • Do not do this with the head in neutral position or the debris may be pushed back into the pharynx.
    • Leave well-fitting dentures in place as they will help to maintain airway contour and make ventilation easier.

  • Do good chest compressions at a rate of approximately 100/min:

    • The emphasis now is on good quality chest compressions, and in a BLS station you will get marks for this!
    • Place the palm of one hand on the lower third of the sternum (Figure 68.4).
    • Place your other hand on top of the first, and interlock the fingers. The pressure needs to be on the sternum and not the ribs, so your fingers should be away from the chest wall.
    • The chest should be depressed to a depth that is approximately one-third of its anteroposterior dimension, or about 4–5 cm.
    • The rate should be at approximately 100/min.
    • Count out loud while you do this, so that the examiner knows you know how many to do.

  • After 30 chest compressions, give 2 ventilations:

    • Open the airway adequately and remove any obstructions.
    • Form a good seal around the patient’s mouth.
    • Inflate their chest for approximately 1 second.
    • Between breaths, maintain an open airway.
    • Watch for chest movement; if the chest wall does not move, your ventilation has been ineffective.
    • In hospital, you should use a self-inflating bag-valve-mask (e.g. Ambu-bag) rather than your mouth for ventilation (Figure 68.5). This should always be a two-person technique as you obtain a better seal between the mask and the patient’s mouth.
    • Do not waste time if you have been unsuccessful in giving two good ventilations. There should be two attempts at effective ventilation, but no more. Instead, immediately recommence chest compressions. The Resuscitation Council (UK) suggests that continuous chest compressions with minimal interruption are associated with a better outcome.

  • Continue in a 30:2 fashion until:

    • There is a return of spontaneous circulation
    • You are exhausted
    • Help arrives – in which case, continue CPR until the help takes over

  • Following return of spontaneous circulation, put the patient in the recovery position, as pictured in Figure 68.6.
  • BLS is a simple but essential skill.
  • If you are unpractised, it will show in the exam.
  • You must go your clinical skills centre, familiarise yourself with the exam manikins if possible, and practise.


Figure 68.1 The Adult Basic Life Support Algorithm.


Reproduced with kind permission of the Resuscitation Council (UK)


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May 17, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Basic life support

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