Out-of-hospital cardiocerebral resuscitation

The out-of-hospital management of the collapsed patient is outlined in figure 1. A number of points related to this management need to be remembered.

• Assess consciousness by shaking the patient’s shoulders gently and checking his/her ability to make an understandable response to the question “Are you all right?”
• Check for breathing for a maximum of 10 s. If absent, treat as cardiac arrest
• Agonal, gasping breathing is a sign of cardiac arrest or near cardiac arrest. Treat the patient as if he/she is not breathing
• If you are on your own and do not have a mobile phone and it is necessary to call an ambulance, leave the patient to do so
• Breaths can be provided by mouth-mouth, mouth-nose or mouth-mask ventilation. There are only isolated reports of transmission of infection to providers of mouth-mouth ventilation. There are no reports of transmission of HIV. Nevertheless if you are unwilling to provide mouth-mouth ventilation it is still worthwhile to provide chest compressions even without providing ventilation
• Do not provide mouth-mouth ventilation to victims of cyanide poisoning or who have been exposed to toxic agents
• Stop chest compressions and ventilation only when the patient starts regular breathing of normal depth
• If an automatic defibrillator is available, use it