A Patient fall down from the height and you are the witness and after initial assessment reveals that the victim has no pulse or breathing. Which action should be taken next after the emergency call?

1. A

   Start CPR

2. B

   Inform Physician

3. C

   Give 10-12 breaths then reassess

4. D

   Give 20-22 breaths then assess for 2 minutes

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

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• The patient's condition (no pulse, no breathing) indicates cardiac arrest, which requires immediate intervention.
• According to Basic Life Support (BLS) guidelines, the immediate next step after calling for help in a cardiac arrest situation is to start high-quality CPR.
• The recommended sequence for adults is C-A-B (Compressions, Airway, Breathing), meaning chest compressions must be initiated first to restore circulation.
• Delaying CPR to perform any other action significantly reduces the chances of survival.

Why Other Options Were Wrong

• Option B: Informing a physician is not the immediate priority in an out-of-hospital cardiac arrest. This action delays critical, life-saving CPR.
• Option C: Giving 10-12 breaths per minute (one breath every 5-6 seconds) is the correct procedure for rescue breathing in a patient who has a palpable pulse but is not breathing (respiratory arrest). This victim has no pulse.
• Option D: This is not a standard or recommended protocol in any BLS or ACLS guideline. Giving this many breaths would lead to harmful hyperventilation, which increases intrathoracic pressure and decreases the effectiveness of CPR.

Related Visual

• Visual 1: Flowchart - A flowchart illustrating the adult BLS algorithm, starting from checking for responsiveness to initiating CPR and using an AED.
• Visual 2: Diagram - A diagram showing the correct hand placement for chest compressions on an adult's sternum.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Basic Life Support (BLS) for an adult trauma patient in cardiac arrest in acute care settings.
• Immediate initiation of high-quality CPR is a critical link in the 'Chain of Survival' and is the most significant factor in improving outcomes from out-of-hospital cardiac arrest.
• Nurses must be able to instantly recognize cardiac arrest and initiate BLS without hesitation, as every minute without CPR decreases the chance of survival by about 10%.
• In a trauma patient (fall from height), it is crucial to provide CPR while minimizing movement of the head and neck. The jaw-thrust maneuver is preferred for opening the airway, but if it is not effective or the rescuer is not trained, the head-tilt-chin-lift can be used cautiously.

How to Approach the Question

• First, analyze the clinical scenario presented in the question stem. Identify the key patient findings: a fall (trauma), unresponsive, no pulse, and no breathing.
• Recognize that the combination of no pulse and no breathing defines clinical cardiac arrest.
• Recall the standard Basic Life Support (BLS) algorithm for an adult in cardiac arrest.
• Note that an essential first step (calling for help) has already been completed. The question asks for the next action.
• Apply the C-A-B (Compressions-Airway-Breathing) principle. The first intervention is to start chest compressions.
• Evaluate the given options against the correct BLS sequence. Eliminate options that are incorrect for the patient's condition (e.g., rescue breathing for a patient with no pulse) or that delay definitive care.

Concept Tested & Keywords

• Concept Tested: Basic Life Support (BLS) for an adult trauma patient in cardiac arrest.
• Stem keywords: Patient fall, no pulse, no breathing, emergency call
• Lead-in keywords: action should be taken next
• Clinical cues: Fall from height suggests potential for traumatic injuries, including spinal injury.
• Clinical cues: Absence of pulse and breathing are the defining signs of cardiac arrest.

Question ID

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