You come upon an unconscious victim with a palpable pulse. He does not appear to be breathing. You are unable to deliver the first breath. What is the next step?

1. A

   Begin CPR

2. B

   Repeat the head tilt/chin maneuver and attempt the breath again

3. C

   Abdominal thrusts

4. D

   Heimlich maneuver

Appeared in: GMCH Chandigarh - 2019

Explanation

• In Basic Life Support (BLS), if the first rescue breath for a victim with a pulse does not cause the chest to rise, the immediate next step is to reposition the airway.
• The most frequent cause of a failed rescue breath is an improperly performed head tilt/chin-lift, leading to a partially or fully closed airway.
• By repeating the head tilt/chin-lift maneuver, the rescuer ensures the tongue is lifted off the back of the throat, providing a clear path for the second breath attempt.
• Only after a second failed breath attempt should the rescuer suspect a foreign body airway obstruction and move to chest compressions.

Why Other Options Were Wrong

• Option A: Beginning CPR, which includes chest compressions, is incorrect because the victim has a palpable pulse. The primary issue is respiratory arrest, not cardiac arrest.
• Option C: Abdominal thrusts are the intervention for a conscious choking victim who is unable to cough or speak. They are not performed on an unconscious person.
• Option D: The Heimlich maneuver is another name for abdominal thrusts and is incorrect for the same reasons. It is not used for unconscious victims.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Basic Life Support (BLS) for an unconscious victim with a pulse but not breathing as background academic context rather than a clinical decision trigger.
• Following the BLS algorithm sequentially is critical for patient survival. Skipping the step of repositioning the airway and moving directly to compressions or other maneuvers wastes valuable time and delays effective ventilation.
• Nurses must be able to quickly differentiate between respiratory arrest (pulse present, no breathing) and cardiac arrest (no pulse, no breathing) as the initial interventions are different.
• What if? If a spinal injury is suspected (e.g., after a fall or car accident), the jaw-thrust maneuver should be used instead of the head tilt/chin-lift to open the airway, as it minimizes neck movement.

How to Approach the Question

• First, analyze the victim's status from the stem: Unconscious, has a pulse, not breathing.
• This combination indicates respiratory arrest, not cardiac arrest. The correct intervention is rescue breathing.
• Next, identify the problem encountered: The first rescue breath was unsuccessful.
• Recall the standard BLS algorithm for failed rescue breaths. The protocol prioritizes re-establishing a patent airway before assuming an obstruction.
• Evaluate the options based on the algorithm. The correct next step is to reposition the airway (head tilt/chin-lift) and try again.
• Eliminate other options: CPR is for no pulse, and abdominal thrusts/Heimlich are for conscious choking.

Concept Tested & Keywords

• Concept Tested: Basic Life Support (BLS) for an unconscious victim with a pulse but not breathing.
• Stem keywords: unconscious victim, palpable pulse, not breathing, unable to deliver breath
• Lead-in keywords: next step
• Clinical cues: The presence of a palpable pulse is a critical cue that differentiates the required action from full CPR.

Question ID

QiUQ94rAabIzM2Wf0NNw7X

Copy ID

Reference Book

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart B (pp 276-535 of 550) pp. 181-183, 182-184