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Basic Life Support (BLS) for Adult - Health Nursing OSCE

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The Chain of Survival

1. Early recognition of cardiac arrest and call for help
2. Early CPR to buy time
3. Early defibrillation (AED use)
4. Early Advanced Life Support (ALS)

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The Adult BLS Algorithm (AHA 2020/2025 - Healthcare Provider)

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Step-by-Step OSCE Breakdown

STEP 1 - Ensure Personal Safety (Scene Safety)

• Look around for any hazards before approaching (electrical wires, traffic, chemicals, sharps)
• Don gloves and other PPE as soon as possible
• Be careful with sharps throughout resuscitation
• If YOU are injured, you cannot help the patient - take scene safety seriously

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STEP 2 - Check for Response

• Approach the patient
• Gently shake both shoulders and shout: "Hello, can you hear me?" or "Are you alright?"
• Do not shake vigorously if a spinal injury is suspected

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STEP 3 - Shout for Help

• Shout for help from those nearby immediately
• You cannot effectively assess and manage alone
• Send someone to call the crash/resuscitation team
• Ask a second person to retrieve the AED

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STEP 4 - Position the Patient and Open the Airway

• Place the patient supine (on their back) on a firm, flat surface
• Perform the Head-Tilt Chin-Lift manoeuvre:
  • Place one hand on the forehead and two fingers under the chin
  • Tilt the head back while lifting the chin forward to extend the neck
  • This lifts the tongue away from the posterior pharynx
• If spinal injury is suspected: Use the Jaw Thrust instead:
  • Place two fingers under the angle of the mandible (both sides), thumbs on cheeks
  • Lift the mandible forwards without moving the neck
• Inspect the mouth for visible foreign bodies or dentures - remove them if accessible

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STEP 5 - Assess for Signs of Life (No more than 10 seconds)

• Look: observe for chest rising and falling
• Listen: ear close to mouth - any breath sounds?
• Feel: air blowing against your cheek?
• Check for no more than 10 seconds

• Place two fingers over the carotid artery (lateral to the trachea, below the jaw)
• Check for no more than 10 seconds
• If you do not definitely feel a pulse within 10 seconds - start CPR
• Healthcare providers have difficulty detecting a weak pulse; do not waste time - Miller's Anesthesia, 10e

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STEP 6 - Call the Resuscitation (Crash) Team

• Dial the emergency number (911 / 999 / hospital crash number)
• Shout "Cardiac arrest!" and direct someone specifically to make the call
• In hospital: call the resuscitation team AND ensure AED/defibrillator is on its way
• If alone: make the call first, then start CPR (except in children or suspected drowning, where CPR takes priority)

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STEP 7 - Start CPR (C-A-B Sequence)

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CHEST COMPRESSIONS (The Primary Element)

• Expose the chest
• Place the heel of one hand on the centre of the chest (lower half of the sternum)
• Place the heel of the other hand on top, interlace fingers
• Keep fingers off the ribs

• Kneel or stand beside the patient
• Arms straight (elbows locked) - this provides a less tiring and more forceful action
• Shoulders directly over your hands

• "Push hard, push fast" - compressions are more often too shallow than too deep in practice - Miller's Anesthesia, 10e
• Rates above 140/min result in inadequate depth - avoid excessively fast compressions
• Switch compressors every 2 minutes to avoid fatigue and maintain quality

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RESCUE BREATHING (Ventilation)

• Pinch the nostrils closed (thumb and index finger)
• Form a tight seal over the patient's mouth
• Deliver 2 breaths, each over ~1 second, watching for chest rise
• Release nostrils and observe for chest fall
• If chest does not rise: re-tilt the head, re-check for obstructions, and try again

• Apply the mask with a C-E grip (thumb and index form a 'C' around the mask; remaining three fingers lift the jaw in an 'E')
• Give 2 breaths, each over ~1 second, watching for visible chest rise
• With two rescuers, one compresses and one manages the airway/BVM
• Add supplemental oxygen as soon as available

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COMPRESSION-ONLY CPR

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STEP 8 - AED Use (Defibrillation)

• Apply AED as soon as it arrives - do not delay
• Turn on AED and follow voice prompts
• Attach pads:
  • One pad: right clavicle / upper right chest
  • One pad: left lateral chest, below the axilla (V6 position)
• Stand clear while AED analyses rhythm (pause compressions)
• If shockable rhythm (VF/pVT): deliver shock, then immediately resume CPR for 2 minutes
• If non-shockable rhythm (PEA/asystole): resume CPR immediately for 2 minutes
• Recheck rhythm every 2 minutes as prompted by the AED

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STEP 9 - Continue CPR Until...

1. The patient shows signs of life (starts breathing normally, moving purposefully)
2. The ALS/resuscitation team takes over
3. A doctor makes the decision to stop resuscitation
4. You become physically exhausted and no one else can take over

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STEP 10 - Recovery Position (if the patient regains spontaneous circulation - ROSC)

• Place in the recovery position (lateral decubitus)
• Monitor using ABCDE approach:
  • Airway: ensure patent
  • Breathing: administer supplemental O₂, monitor SpO₂
  • Circulation: measure BP, obtain IV access, attach ECG monitoring
  • Disability: assess AVPU or GCS, check capillary blood glucose
  • Exposure: look for trauma, rash, bleeding
• Prepare SBAR handover for the attending team

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Summary Table: High-Quality CPR Components (OSCE Quick Reference)

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Common OSCE Errors to Avoid

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Sources

• Goldman-Cecil Medicine International Edition, Cardiac Arrest and Sudden Cardiac Death
• Miller's Anesthesia, 10e - BLS chapter (AHA 2020 Guidelines)
• Fuster and Hurst's The Heart, 15th Edition - BLS Healthcare Provider section
• Geeky Medics BLS OSCE Guide (ERC guidelines, clinical OSCE format)
• AHA 2025 Adult BLS Guidelines