Step Action Marks

1 Call for help 1

2 Check for signs of life – consciousness, breathing, pulse 4
3 Call cardiac arrest team 1
4 Start basic life support until defibrillator is available 4
5 Chest compression
 Correct technique: arms straight, shoulder vertically 4
above sternum, compress with heel of the hand, fingers
interlocked
 Correct position: middle of the lower half of the sternum 1
 Correct depth: 5 – 6 cm 1
 Correct rate: 100 – 120 bpm 1
 Allow full chest recoil while retaining contact between 1
hand and sternum
 Time of compression: time of recoil = 1:1 1
 Switch of person every 2 minutes/5 cycles 1
Sub-total 10
6 Bag-valve-mask ventilation
 Basic airway maneuvers: head tilt, chin lift 2
 Mask covering mouth and nose 2
 Tight seal: C-E grip 2
 Correct tidal volume: 300-500ml, a quarter of the bag 2
 Positive chest movement 1
 Coordinate with chest compressions at a 30:2 ratio 1
Sub-total 10
7 Use of defibrillator
 Turn on the defibrillator with correct settings 1
 Attach the corresponding adhesive pads to correct 2
positions (Sternum and Apex)
 Minimize interruption to chest compressions 1
 Stop compression and analyze rhythm 1
Shockable rhythm (VF/VT)
Check pulse if VT 1
Charge the defibrillator appropriately 2
o 360J if monophasic
o 150-200 J if biphasic
Remove oxygen delivery device if there is any and place if 2
>1m away from the patient
Ensure safety: 3
o Verbal warning: Stand clear
o Visual check on self and others
 Deliver shock 1
Resume chest compression and ventilation 1
Non-shockable rhythm
Check for any pulse (omit if asystole) 5
Resume chest compression and ventilation 5
Sub-total 15
8 Gain intravenous access 3
9 Medication
Epinephrine: 10
o Correct dosage: 1mg every 3-5 minutes
o Correct route: Intravenous
o Correct timing:
 VF/VT: first dose after the third shock
 Non-VT/VF: first dose as soon as chest
compression and ventilation start and IV
access is available
Amiodarone (for unstable, shock resistant VF/VT): 10
o Correct dosage: 300mg over 10 minutes, 60mg/hr for
6 hours, then 30mg/hr (total 2g/day)
o Correct route: Intravenous
o Correct timing: After 3 shocks delivered
Sub-total 20
10 Look for and treat for reversible causes (5 H and 5 T) 3
11 Check electrode position and contact, airway and O2 3
12 Consider the need for endotracheal intubation and 3
capnography
13 Clear documentation of events 3
Total 80