Proformas
BLS and Airway Management
Overview and approach
Indications: BLS for anyone unresponsive and not breathing normally (occasional gasps count as abnormal); basic airway manoeuvres for upper airway obstruction from reduced consciousness (snoring, gurgling, hypoxia, no mask fogging) (1)(2)(5).
Contraindications/cautions: head-tilt chin-lift in suspected cervical spine injury (use jaw thrust); Guedel (OPA) only if unconscious (gags and aspiration risk otherwise); NPA avoided with suspected skull-base fracture (3)(4).
Equipment: gloves/PPE, suction, bag-valve-mask (BVM) with high-flow oxygen, pocket mask, OPA and NPA in several sizes, lubricant, AED with pads and razor, flat firm surface or back board (1).
Prep: check scene safety first (you cannot help if injured), glove up, beware sharps, and shout for help early since BLS cannot be done well alone (1).
The chain of survival: early recognition and call for help, early CPR, early defibrillation, early advanced life support (1).
Assessment and clinical features
Step-by-step (ANZCOR DRSABCD, hospital version) (1)(5):
- Danger: scene, sharps, fluids, other people, seizure activity.
- Response: shake shoulders and ask loudly "can you hear me?" (e.g. name, eyes open, pain via shoulder push or sternal rub). Responds: urgent ABCDE and medical review.
- Send for help: in hospital activate the emergency team (e.g. CODE BLUE 222; the UK uses 2222). State exact location and adult or paediatric arrest.
- Airway: position supine, head-tilt chin-lift (jaw thrust if trauma), look in the mouth, remove only visible obstruction by suction or finger sweep.
- Breathing: look, listen and feel for up to 10 seconds with the chest exposed; occasional irregular gasps are agonal breathing, not breathing. Short seizure-like activity can occur at the start of arrest.
- CPR: patient on a flat hard surface; heel of hand on the lower half of the sternum, other hand on top; 30 compressions then 2 breaths; rate 100-120/min; depth about one third of chest depth (5-6 cm in adults); full recoil; minimise pauses; swap compressor about every 2 minutes (1)(5).
- Breaths: head-tilt chin-lift, pinch the nose, seal mouth (pocket mask or BVM preferred in hospital), about 1 second each, watch the chest rise; add oxygen as soon as possible. If you cannot ventilate, continue compressions only (1).
- Defibrillation: attach the AED as soon as it arrives. Pad 1 right of the sternum below the clavicle, pad 2 left mid-axillary line with long axis vertical; shave if needed, remove piercings but do not delay; follow prompts, stand clear, shock, resume CPR immediately (1)(5).
- Pulse present but breathing slow (<12/min): assist with BVM about 10 breaths/min and recheck pulse each minute (1).
- Handover with ISBAR to the arriving team.
Your BLS checklist (kept)
- Say Name
- **Danger **
- **Response **(Open eyes, say name, push on shoulders, above eyes, sternal rub)
- **Send for Help **CODE blue 222
- **Airways **(clear) and
- **Breathing **(check for breathing, look, feel)
- CPR
- Defib
- **Assist breathing **(2 per 30) and swap after 2 rotations
- **Hand Over ISBAR **to resuscitation team
Airway management: technique notes (2)(3)(4)
- Head-tilt chin-lift: one hand on forehead, other fingers under the chin; tilt back and lift chin forward. Not for suspected spinal injury.
- Jaw thrust: two fingers behind the angle of the mandible on both sides, thumbs on cheeks, lift the jaw forward and slightly open the mouth. Safe in suspected spinal injury.
- OPA (Guedel): size from the corner of the jaw (angle of mandible) to the centre of the upper incisors; check the mouth, insert upside-down to the junction of hard and soft palate, rotate 180 degrees, advance until the flange sits at the lips; keep manoeuvre and reassess look-listen-feel. Children: insert the right way up with a tongue depressor.
- NPA: size nose tip to tragus (usually 6-7 mm women, 7-8 mm men); check the right nostril, lubricate, insert bevel-first along the nasal floor (not upward), try the other nostril if resistance; flange rests at the nostril. Better tolerated in semi-conscious patients.
- Then suction, BVM (one or two person technique), and appropriate oxygen therapy.
Your airway notes and image (kept)
Head tilt is contraindicated in a patient with a cervical spine injury
- Check for Danger (other people, floor things, patient seizure)
- Response of the patient (A Verbal, Pain, Unresponsive)
- Quick Observation and say most important such as low BP and low O2 stat
- Recognise upper airway obstruction (RR, added sounds, chest rise diminished)
- Send for Help (METCALL)
- Check equipment (suction, BVM device, oxygen)
- Hand Hygiene
- Open Airway (Examine and Jaw thrust, insert Guedel tube (Oropharyngeal tube) and NFT)
- Normal Breathing (Look, Listen, Feel)+ listen to lung sounds for bronchial breath sounds and added sounds
- Simple airway adjuncts
- Suctioning of airway
- BVM ventilation - single and double handed
- Appropriate oxygen therapy
- Normal Breathing?
- Circulation (carotid pulse, central and peripheral capilary refill, HR, sweating, pale)
- Disability (diabetes - glucose test
- Exposure - check rest of body for
Differentials and investigations
What to check and interpret:
- Unresponsive: consider reversible causes while CPR continues (hypoxia, hypovolaemia, hypo/hyperkalaemia and metabolic, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis), plus seizure, syncope, hypoglycaemia (capillary glucose) and opioid toxicity.
- Airway obstruction clues: snoring (tongue), gurgling (fluid, needs suction), stridor (upper airway narrowing, call early), paradoxical see-saw chest movement.
- Adequate CPR: visible chest rise with breaths, recoil between compressions, compression rate and depth feedback, ETCO2 if monitored.
- Complications: rib/sternal fractures, gastric inflation, regurgitation and aspiration, pad burns, injury to rescuer. ANZCOR advises starting CPR for presumed arrest despite risk of injury if the patient is not in arrest (5).
- Troubleshooting airway adjuncts: gagging means the OPA is in a conscious patient (remove); NPA resists (try other nostril, smaller size); leak with BVM (re-seat the mask, two-hand technique, add an adjunct) (2)(3)(4).
Management and follow-up
- Continue until the patient responds, a clinician takes over, or the team leader stops resuscitation (5).
- If signs of life return: call urgent medical review, repeat ABCDE (oxygen and SpO2, BP, IV access, ECG monitoring, AVPU/GCS and glucose, expose for trauma or rash) (1).
- Handover (ISBAR): Identify (team, patient), Situation (arrest, time of onset, rhythm), Background (history, allergies, code status), Assessment (what was done, shocks, response), Request/Recommendation.
- Documentation: times of recognition, call, CPR start, shocks and their rhythm, airway adjuncts, drugs, who was present; complete the cardiac arrest record and debrief the team.
Red flags and clinical pearls
- OSCE tips: say "I would ensure the scene is safe and put on gloves"; shout for help before leaving the patient only if you are alone and must go; verbalise "no signs of life, no pulse" after a timed check; state compressions 100-120/min and depth 5-6 cm; ask for the AED and oxygen.
- Common mistakes: leaning on the chest (no recoil), pausing too long for breaths or checks, compressing on a soft mattress, forgetting jaw thrust in trauma, wrong OPA size (too small pushes tongue back; too big can obstruct), forcing an NPA against resistance, delay to AED.
- Pearls: agonal gasps are not breathing; rotate compressors on time; if only compressions are possible, do them; in trauma use jaw thrust plus manual in-line stabilisation.
- Untrained or lay rescuers are not required to check pulses; trained clinicians should do so for up to 10 seconds (1)(5).
Last updated from Sen’s notes on 9 October 2026.