Cardiopulmonary arrest, choking and emergency help

Recognise arrest and begin help

Check for danger, responsiveness and normal breathing, call for help and obtain an AED. An unresponsive person who is not breathing normally needs CPR; occasional gasps are not normal breathing. A prolonged attempt to feel a pulse must not delay resuscitation. Follow the ANZCOR basic-life-support sequence, with local clinical emergency activation in healthcare settings. Ask a specific bystander to call emergency services and another to obtain the AED when people are available; vague requests can leave everyone assuming someone else acted.

Give high-quality chest compressions with full recoil and minimal interruptions. ANZCOR recommends a rate of 100–120 per minute and approximately one-third chest depth, with adequate adult depth exceeding five centimetres. For basic adult CPR use thirty compressions to two breaths when able and willing; compression-only CPR is preferable to no CPR when rescue breaths cannot be given. Paediatric trained-team and newborn algorithms differ and must not be silently substituted. Avoid delaying compressions while assembling equipment that is not immediately available.

AED and advanced care

Attach the AED promptly, follow its prompts and ensure nobody touches the patient during analysis/shock. Resume compressions immediately as instructed rather than repeatedly pausing to seek a pulse after each shock. A shockable rhythm such as VF/pulseless VT needs defibrillation; asystole/PEA requires CPR and the non-shockable pathway. Drug timing, energy and airway choices follow the current advanced-life-support protocol and team competence. Defibrillation is not a treatment for every flat-line rhythm.

Clinical teams search for reversible causes including hypoxia, hypovolaemia, major electrolyte/metabolic disturbance, hypothermia, tension pneumothorax, tamponade, thrombosis and toxins. The mnemonic supports assessment but does not replace actual evidence. Obtain appropriate airway/ventilation support, minimise interruption for procedures and use a team leader and closed-loop communication. Record times and interventions. A difficult airway or procedure should trigger early expert help rather than repeated attempts that interrupt compressions and worsen oxygenation.

After circulation returns

Return of spontaneous circulation is a transition to ongoing care, not the end of the emergency. Support oxygenation and ventilation, avoid hypotension, assess ECG and likely cause, control temperature according to the current pathway and arrange critical-care/cardiology support as indicated. Over-oxygenation and excessive ventilation can be harmful. Neurological prognosis is assessed at appropriate timing with a multimodal specialist process; immediate unconsciousness after resuscitation does not justify a definitive poor-prognosis statement. Sedatives, temperature and metabolic factors confound examination.

Communicate with family honestly about what happened, current uncertainty and the plan. Review advance directives and goals through appropriate processes, without using an unverified family recollection to terminate an active emergency casually. Debrief the team and document decisions. A limitation-of-treatment order should specify its scope and be accessible; it does not imply that every acute symptom receives no treatment. The professional duty includes good handover to the receiving service and support after a distressing event.

Choking

With an effective cough, encourage coughing and monitor. With ineffective cough and a responsive patient, send for help and give up to five back blows, checking after each, followed by up to five chest thrusts if needed, then repeat according to ANZCOR. The aim is to clear the obstruction with each action, not mechanically finish all five after success. Australian guidance uses chest thrusts rather than importing routine abdominal thrusts as the default. Infant positioning and technique require age-specific guidance.

If the person becomes unresponsive and is not breathing normally, start CPR. Remove only visible accessible material; blind finger sweeps can push an object deeper or injure the airway. A partial obstruction can worsen, so deterioration needs immediate action. After the event, assess residual symptoms, injury and aspiration. A child with persistent cough, unilateral wheeze or unexplained recurrent respiratory symptoms may have an inhaled foreign body despite a normal radiograph; arrange appropriate specialist assessment rather than assuming asthma.

Rendering assistance within competence

When encountering an emergency outside work, assess personal and scene safety, summon assistance and provide suitable aid within competence. Do not assume possession of a medical qualification makes every procedure safe without equipment or training. Legal protections and duties differ by jurisdiction, but professional expectations support reasonable assistance. Coordinate with emergency responders and provide the history and interventions clearly. In a disaster or crowded scene, priorities and allocation follow the relevant emergency system rather than individual improvisation.

For example, a collapsed adult with irregular gasps needs CPR and an AED, not observation for a normal respiratory pattern to return. A conscious choking person who cannot speak needs the ineffective-cough sequence, not water or a blind mouth search. A shocked patient regaining circulation still needs monitored transfer and cause-directed care. These scenarios test timely recognition, effective basic actions and a disciplined handover.

ANZCOR airway/choking, compressions and CPR.

Review checkpoints

• Adult CPR uses compressions at 100–120 per minute with minimal interruptions.
• ANZCOR uses back blows and chest thrusts for conscious severe choking.
• Do not perform blind finger sweeps when an airway foreign body is not visible.