Adult Basic Life Support Algorithm

 
Check Responsiveness
Shake and Shout

Open Airway
Head tilt/chin lift

Check Breathing If breathing place in

Look, listen and feel recovery position

Start chest compression

Signs of circulation
Assess 10 seconds only
2 effective breaths
Circulation present No circulation
Continue Rescue Breathing Compress chest
Rate of 100 per second
30 compression to 2 breaths
(30:2)

Intravenous Cannulation
1. Use the forearm or preferably veins of dorsum of hand for
the insertion of the cannula. FG16 or FG18 (pink or
green) are the most commonly selected sizes. Do not
use a cannula smaller than FG16 for blood
transfusions. Subcutaneous infiltrations of local
anaesthetic may obscure the position of the
underlying vein.
2. Cleanse the skin. Apply a tourniquet.
3. Insert the cannula with a bevel upwards obliquely to the skin
whilst fixing the vein by skin tension. When blood is
seen to ‘flash-back’, gently advance the plastic outer
cannula over the needle into the vein and withdraw
the needle.
4. Blood can be withdrawn now if necessary.
5. Screw on the retaining cap to prevent retrograde flow of
blood.
6. Secure the cannula with tape of and a bandage for added
security. A splint will be necessary if an antecubital
vein is selected.
7. Flush the cannula with sterile saline to check patency
Venepuncture
1. Common sites are the antecubital fossa, the dorsum of the
hand or the femoral vein.
2. Collect together all the necessary equipment (Vacutainer
system) and wear gloves.
3. Explain procedure to patient.
4. Apply a tourniquet proximal to the venepuncture site.
5. Clean the skin with an alcohol swab and allow to dry.
6. Fix vein with traction and insert needle with bevel upwards.
Withdraw sufficient sample for investigation.
7. Release tourniquet and remove needle. Apply pressure for 2
minutes with the arm straight.
8. Immediately label the sample tubes. Dispose of sharps
Subcutaneous injection
1. Heparin and insulin for example can be easily administrated
by this route.
2. Common sites include the outer aspect of the upper arm,
anterior abdominal wall or the thigh.
3. Cleanse skin. Select small orange needle.
4. Insert needle just under surface of skin rapidly, inject slowly
and withdraw. Try not to use exactly the same site
each time as bruising may occur, especially with
prophylactic Heparin.
Intramuscular injection
1. Common sites for IM injections are the deltoid, buttock and
anterior thigh areas. The upper outer quadrant of the
buttock is probably the most versatile.
2. Cleanse the skin.
3. Place the outstretched left hand on the right buttock,
delineating the upper outer quadrant to avoid
damage to the sciatic nerve.
4. Place the skin under tension and insert the needle with a
quick stab movement at 90 degrees to the skin.
5. Aspirate to ensure not in blood vessel.
6. Inject slowly.
7. Withdraw needle rapidly and rub the area.
Arterial Blood Gases
1. Common sites include the radial, brachial and femoral
arteries. If contemplating selecting a radial artery,
ensure the ulna artery is functioning beforehand.
2. Prime the blood gas syringe (Pulsator) by expelling excess
Heparin and air from the syringe.
3. Cleanse the skin.
4. Select the site by palpating the relevant artery proximal to
the proposed puncture site and insert the needle into
the vessel at approximately 45 degrees to the skin.
The plunger should rise spontaneously on entering the
artery due to the high pressure. Obtain 5ml and
remove needle from tube and place cap on the
syringe.
5. Apply firm pressure to the puncture site for at least 5
minutes.
6. If the sample is likely to be in transit for more than 5
minutes then pack in ice.
7. Make a note of the inspired oxygen concentration at time of
taking sample.
Electrocardiograph
1. Place patient in a relaxed position and reassure.
2.           Attach the limb leads to hairless distal aspects of the
limbs, ensuring a good electrical              contact with gel or
adhesive pads. These leads are usually colour coded:
 RA—Right arm       RED
 LA—Left arm        YELLOW
 LF-Left foot         GREEN
 RF—Right foot      BLACK
(Ride Your Green Bike)
 
3. Attach the chest leads as follows:
 V1 Right sternal edge, 4th intercostal space
 V2 Left sternal edge, 4th intercostal space
 V3 Half way between V2 and V4
 V4 Mid clavicular line, 5th intercostal space
All subsequent leads are at the same horizontal level as the V4
lead
 V5 Anterior axillary line
 V6 Mid axillary line
As a guide, the second intercostal space is just below the
sternal angle. V4 should correspond to the apex beat of the
heart.
4. Most ECG machines are fully automated and will add a
rhythm strip to the tracing. Ask the patient to remain
perfectly still during the recording and do not touch
the leads or patient during this time
Closure of Skin Lacerations:
Prepare the skin with aqueous Betadine or Trisept (make sure
patient has no known allergies).
Infiltrate area with local anaesthetic—be careful of using
adrenaline in ischaemic looking tissues.
Clean, debride and irrigate with saline.
The depth of the wound should be carefully assessed to
determine whether the facial muscles have been divided. The
muscle should be carefully repaired using absorbable sutures.
Failure to repair the muscle layer will result in a sunken scar,
giving an unsatisfactory cosmetic result.
Aim to try and preserve as much skin as possible, as the
vascularity of the face usually ensures good healing.
If deep sutures needed use 3/0 SGS or 3/0, 4/0 Vicryl undyed.
Use 5/0, 6/0 Prolene or Ethalon on the skin.
Prescribe 500mg Flucloxacillin QDS 3/7 or 500mg Erythromycin
QDS 3/7 and Polyfax ointment.
Review on clinic in 5/7 for suture removal or to GMP.
Make sure patient is up-to-date with Tetanus vaccination.
Intra-oral/ vermillion border:
 Vicryl 3/0, 4/0, Softgut 3/0
 Chromic Catgut 3/0
Skin: normally use non-resorbable mono-filament to reduce
scarring:
Eyelids:                Novofil 6/0
                          Prolene 6/0
Face:                   Novofil 5/0
                          Prolene 5/0
Scalp:                  Black Silk 3/0
                          Novofil 4/0, 3/0
                          Vicryl 3/0. 4/0
Children:             Novofil 5/0, 6/0
                          Vicryl 6/0 (fine enough that there is minimal
scarring, but do not need to be removed).
Types of suture:
Braided:               Resorbable                        Vicryl
                          Non-resorbable                  Black Silk
Monofilament:      Resorbable                        Soft Gut
                                                                 Cat Gut
                          Non-resorbable                  Prolene  
                                                                 Novofil
                                                                 Ethilon
Closure of Dog Bites/ Human Bites
Prepare the skin with aqueous Betadine or Trisept (make sure
patient has no allergies).
Infiltrate area with local anaesthetic—be careful of using
adrenaline in ischaemic looking tissues.
Clean, debride and irrigate with H202 / saline 50:50  and wash
thoroughly with saline.
If deep sutures needed use 3/0 SGS or 3/0, 4/0 Vicryl undyed.
Use 5/0, 6/0 Prolene or Ethalon on the skin.
Prescribe 375mg Augmentin TDS 5/7 and 400mg
Metronidazole TDS 5/7 and Polyfax ointment.
Advise to return immediately if would breakdown starts to
occur.
Review on clinic 5/7 for suture removal or to GMP.
Make sure patient is up-to-date with Tetanus.
 Lacerations to the tongue:
Tongue lacerations only require suturing if the tissues are
gaping with the tongue at rest. Bear in mind that a child will
probably need a GA for this. Before suturing the laceration
under LA or GA ensure that there are no foreign bodies in it
e.g.: tooth fragments. When suturing use 3/0 or 4/0 SGS and
invert the knots (ask if you don’t know how to do this). Review
on clinic 5/7 later.