1. Try to rouse the patient by calling his name and tapping him (eg. "Mr Tan, are you ok?" while tapping his shoulders)
2. If there is no response, take his pillow away and lie his head supine (ie. flat) on his bed.
3. Open airway by doing "head tilt, chin lift". If the patient has a cervical injury, perform jaw thrush instead. Inspect for any loose teeth, dentures or other foreign objects that may obstruct airway and remove these obstructions.
4. Check for presence of breathing by doing "look, listen & feel". Look for signs of breathing like chest rising; listen for breath sounds; feel for air exhaled from the patient.
5. Check for presence of circulation by feeling for the carotid pulse. If there is no pulse, activate "CODE BLUE" immediately.
If there is pulse, provide oxygen to the patient at a rate of 12 breaths/ min using a bag-valve-mask (BVM). ie. provide oxygen (by squeezing the bag), 2-a-thousand, 3-a-thousand, 4-a-thousand, 5-a-thousand, provide oxygen...
6. If the patient is pulseless, lock and pull the bed out a little before locking it back, set the height of the bed to the level of your thigh, remove the headboard and screen the patient for privacy.
7. Bring the cord side down, shift the patient more to his other side to allow more room for yourself and commence cardiopulmonary rescue (CPR).
8. When the e-trolley is pushed in by another nurse B, get her to attach the 3 leads electrocardiogram (ECG) and stop CPR to obtain the heart's rhythm. Once obtained, continue CPR. The doctor would prepare to "shock" the patient if it is a "shock-able" rhythm; either ventricular fibrillation (VF) or pulseless ventricular tachycardia (pulseless VT).
If sinus rhythm resumes after "shocking" the patient, continue CPR for a minute before checking for pulse unless patient shows signs of circulation eg. moving.
9. If patient's heart rhythm remains the same, nurse B would then insert oropharyngeal airway of suitable size (it should measure from the tragus of the ear to the tip of the mouth on the same side of the patient) to maintain patient's airway. Wear clean plastic gloves as there is a risk of contact with patient's body fluids (ie. saliva, in this case).
10. Nurse B would also assemble the BVM and provide 100% oxygen (15litres) to the patient at a rate of 30 compressions: 2 breaths if pulse is still absent. If pulse is present, continue providing 100% oxygen to the patient at a rate of 12 breaths/ min.
11. If the patient has an IV access, another nurse, C, would check for its patency by withdrawing any blood clots (if any) and then injecting 3-5ml of normal saline; "flushing". Maintain this IV access by running normal saline at a slow rate. If there is no IV plug in situ, prepare for the insertion of an IV plug.
12. Nurse C would also prepare for drugs to be administered when the doctor requests for it (usually, it is 1ml of adrenaline in 9ml of normal saline/ water for injection). If intubation is required, nurse C would prepare the requisites for intubation and suctioning equipment as well.
13. Once intubated, the patient's breathing would be taken over by the ventilator. If pulse returns, prepare to send patient to intensive care unit (ICU). Maintain therapeutic hypothermia for the patient. If pulse has not return, the doctor may administer more drugs/ shock the patient again, depending on the condition.
14. Nurse C should then document all the events/ procedures that happened during the resuscitation eg. the amount and type of drugs infused to the patient at ____ hours and the patient's response to that particular intervention etc.
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