🚨 Collapsed & Unresponsive Adult
➡️ Check safety ⚠️ → Check response 📢 → Call for help / activate emergency response 📞
➡️ Open airway 🤲 → Check breathing for no more than 10 seconds
➡️ Not breathing normally? Call 999 / arrest team and start CPR immediately ❤️‍🔥
➡️ CPR: 30 compressions : 2 breaths if trained and able
➡️ Send for AED / defibrillator and attach as soon as available ⚡

🔄 Basic Life Support (BLS) Overview

BLS aims to maintain cerebral and coronary perfusion until defibrillation and definitive care are available.
Early recognition, early CPR and early defibrillation are major predictors of survival.
Agonal gasps, occasional gasping, seizure-like movements or very abnormal breathing should be treated as not breathing normally.
Do not wait for senior review before starting CPR.
If the patient is unresponsive but breathing normally, place in the recovery position, call for help and monitor closely.

🚦 Arrest or Deteriorating Patient?

Situation	Immediate approach
Unresponsive and not breathing normally	Cardiac arrest pathway: call for help, start CPR, attach AED/defib, follow prompts.
Unresponsive but breathing normally	Recovery position, call for help, monitor breathing, reassess frequently.
Deteriorating patient with signs of life	Use ABCDE assessment and treat problems as they are found.
After ROSC	ABCDE reassessment, oxygenation/ventilation, ECG, BP support, glucose, temperature and senior/ICU review.

🩺 Primary Survey: ABCDE Approach

Use ABCDE for the acutely unwell patient who has signs of life, or after return of spontaneous circulation. In confirmed cardiac arrest, start CPR and defibrillation rather than delaying for a full ABCDE assessment.

Component	Assessment	Immediate Action
🛫 Airway	Patency, obstruction, secretions, vomit, blood, foreign body	Open airway, suction, remove visible obstruction, airway adjuncts if trained
🫁 Breathing	Rate, effort, oxygen saturations, chest symmetry, breath sounds	Oxygen if hypoxic, assist ventilation if inadequate, treat reversible causes
❤️ Circulation	Pulse, BP, capillary refill, skin temperature, bleeding, ECG rhythm	IV access, fluids/blood if indicated, treat shock, CPR if no signs of circulation
🧠 Disability	AVPU/GCS, pupils, glucose, seizures, drugs/toxins	Treat hypoglycaemia, control seizures, consider naloxone if opioid toxicity suspected
🧍 Exposure	Temperature, rash, trauma, bleeding, devices, full examination	Look for clues, treat sepsis/anaphylaxis/trauma, prevent hypothermia

👀 Initial Recognition and Safety

⚠️ Ensure scene safety: traffic, electricity, water, chemicals, violence, sharps.
🤝 Shake shoulders gently and shout: “Are you alright?”
👁️ Look for purposeful movement, normal breathing or speech.
❌ No response = medical emergency.
📞 Activate emergency response early: 999 in the community or arrest team in hospital.

🛫 Airway: Assessment and Management

Loss of airway tone is common in unconscious patients. Tongue obstruction, secretions, vomit, blood or foreign material may obstruct the airway.

🤲 Perform head-tilt / chin-lift unless cervical spine injury is suspected.
📢 Use jaw thrust if cervical spine injury is suspected.
🦷 Remove only visible foreign bodies, vomit or loose dentures.
🪥 Leave well-fitting dentures in place unless loose or obstructing.
🧪 Insert an oropharyngeal or nasopharyngeal airway if trained and appropriate.
📞 Escalate early if airway obstruction persists or GCS is low.

🚫 Signs of Airway Obstruction	🩺 Immediate Management
Snoring, gurgling or stridor Choking or inability to speak Paradoxical chest/abdominal movement Central cyanosis Falling oxygen saturations Reduced consciousness	Airway manoeuvres Suction if available Remove visible obstruction Airway adjuncts if trained High-flow oxygen if breathing but hypoxic Bag-valve-mask ventilation if inadequate breathing Adrenaline IM if anaphylaxis suspected Prepare for advanced airway support

🫁 Breathing: Assessment and Support

Check breathing by looking, listening and feeling for normal breathing for no more than 10 seconds. Agonal gasps are not normal breathing and should trigger CPR.

👁️ Look: chest movement, respiratory effort, symmetry, cyanosis.
👂 Listen: breath sounds, stridor, wheeze, gurgling.
🤚 Feel: airflow at the mouth/nose.
⏱️ Assess breathing for ≤10 seconds.
⚠️ Agonal gasps, occasional gasping or abnormal breathing = treat as cardiac arrest.

💨 Give oxygen if hypoxic or critically unwell and trained to do so.
🫁 Assist ventilation with bag-valve-mask if breathing is inadequate.
📞 Call for senior / anaesthetic / ICU support early if ventilation is failing.

Common Causes of Acute Breathlessness / Respiratory Collapse
Pulmonary oedema Pulmonary embolism Pneumonia or sepsis Pneumothorax, including tension pneumothorax Asthma or COPD exacerbation Anaphylaxis DKA or severe metabolic acidosis Opioid or sedative toxicity

❤️ Circulation: Perfusion and CPR

Loss of effective circulation leads to rapid cerebral hypoxia. High-quality chest compressions maintain some coronary and cerebral perfusion until defibrillation and advanced care are available.

Healthcare professionals may check carotid or femoral pulse, but do not spend more than 10 seconds.
If there are no signs of life, no normal breathing, or doubt about the presence of a pulse, start CPR.
Do not delay CPR for prolonged pulse checks.

❤️‍🔥 High-Quality Chest Compressions

Hands in the centre of the chest, on the lower half of the sternum.
Compression depth: 5–6 cm.
Compression rate: 100–120/min.
Allow full chest recoil.
Minimise interruptions.
Change compressor about every 2 minutes if possible to prevent fatigue.

💋 Rescue Breaths: 30:2

Open airway.
Pinch nose.
Seal mouth over the patient’s mouth.
Give each breath over about 1 second.
Look for visible chest rise.
Give two effective breaths, then restart compressions immediately.

✋ Compression-Only CPR

If untrained, unable or unwilling to give rescue breaths:

Give continuous chest compressions.
Rate 100–120/min.
Minimise pauses.
Use speakerphone so the emergency call handler can guide CPR.

⚡ AED / Defibrillator	Action
Send for AED/defib early	Do not leave the patient if alone unless necessary; ask someone else to fetch it.
Attach pads	Expose chest, attach pads firmly, follow AED/defib prompts.
During analysis/shock	Ensure nobody is touching the patient.
After shock or no shock advised	Restart CPR immediately unless there are clear signs of life.

🩸 Causes of Circulatory Collapse / Arrest
Acute coronary syndrome / malignant arrhythmia Massive pulmonary embolism Major haemorrhage Sepsis Anaphylaxis Cardiogenic shock Cardiac tamponade Tension pneumothorax Severe hypoxia Severe electrolyte disturbance, especially hyperkalaemia

🧠 Disability: Neurological Status

A – Alert
V – Responds to Voice
P – Responds to Pain
U – Unresponsive

🧪 Check capillary glucose early.
💉 Treat hypoglycaemia immediately.
💊 Consider opioid overdose → naloxone if appropriate.
🫁 Low GCS or loss of airway reflexes = airway risk → urgent anaesthetic / senior review.
🧠 Consider CT head once stabilised if neurological cause, trauma or anticoagulation is suspected.

🧍 Exposure: Full Assessment

Undress respectfully and preserve dignity.
Inspect for trauma, bleeding, rash, medical alert jewellery, needle marks or signs of sepsis.
Check drains, catheters, cannulas, medication patches and infusion pumps.
Measure temperature.
Prevent hypothermia and re-cover the patient promptly.

🔁 Reversible Causes of Cardiac Arrest: 4 Hs and 4 Ts

4 Hs	4 Ts
Hypoxia Hypovolaemia Hypo-/hyperkalaemia and metabolic disturbance Hypothermia	Thrombosis — coronary or pulmonary Tension pneumothorax Tamponade Toxins

📌 Key Learning Points

Unresponsive + not breathing normally = cardiac arrest until proven otherwise.
Agonal gasps are not normal breathing.
Start CPR immediately; do not wait for a doctor, monitor or ECG.
High-quality compressions and early defibrillation save lives.
Use ABCDE for patients with signs of life, peri-arrest patients, and after ROSC.

📸 Practical Illustrations

📚 References

Resuscitation Council UK: Adult Basic Life Support Guidelines, 2025.
Resuscitation Council UK: Executive summary of main changes since 2021 guidelines, 2025.
NICE CKS: Cardiac arrest — out-of-hospital care: Basic life support adult.

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Resuscitation - Basic Life Support Cardiac Arrest