Basic Life Support and Emergency Response

Basic Life Support (BLS) is the foundation of emergency nursing care and is among the most critical competencies assessed in the DOH (UAE) examination. Cardiac arrest is a time-sensitive emergency where every minute without CPR reduces the chance of survival by 7–10%. In the UAE, all registered nurses are required to maintain a current BLS provider certificate (from AHA or equivalent DOH-recognised provider), and they are often the first to respond to in-hospital cardiac arrests. Understanding the chain of survival, high-quality CPR techniques, the legal framework around resuscitation in the UAE, and the use of automated external defibrillators (AEDs) is essential for both safe clinical practice and examination success.

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🟢 Lite — Quick Review (1h–1d)

Rapid summary for last-minute revision before your exam.

Adult Cardiac Arrest — BLS Algorithm (2020 AHA Guidelines, adopted by UAE):

1. Check responsiveness — Tap shoulders; shout “Are you okay?”
2. Call for help and get AED — Shout for assistance; activate emergency response system (code blue)
3. Check pulse — Carotid pulse for no more than 10 seconds
4. If no pulse OR uncertain → Start CPR immediately
5. Compression: 30 → Airway: 2 → Breaths (30:2) — Continue until AED arrives
6. AED analysis → Shock if indicated → Resume CPR immediately for 2 minutes
7. Repeat cycle until advanced life support arrives or patient recovers

High-Quality CPR — The 5 Key Components:

Component	Standard
Rate	100–120/min (push hard enough to feel a carotid pulse)
Depth	At least 5 cm (2 inches); maximum 6 cm
Recoil	Allow full chest recoil after each compression
Interruptions	Minimise all interruptions (<10 seconds)
Ratio	30:2 for all single rescuers; 30:2 for 2-person BLS

⚡ Exam Tip: In UAE hospitals, AEDs and code carts are located on every floor. Know exactly where the nearest one is before you need it. During an exam scenario, a candidate who wastes time looking for equipment will fail.

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🟡 Standard — Regular Study (2d–2mo)

Standard content for students with a few days to months.

1. The Chain of Survival

The chain of survival consists of five links — if any link is weak or absent, the chance of survival decreases dramatically:

1. Early recognition and call for help — Identify cardiac arrest immediately; call code blue early
2. Early CPR — Bystander CPR doubles or triples survival; healthcare workers must maintain skills
3. Early defibrillation — Each minute of delay to defibrillation reduces survival by 7–10%; AEDs in public spaces and hospitals throughout UAE
4. Early advanced life support — Paramedics in UAE pre-hospital care; in-hospital resuscitation teams
5. Post-cardiac arrest care — Critical care, targeted temperature management, neurological prognostication

2. CPR for Different Age Groups

Adult (≥8 years):

• Compression depth: ≥5 cm, ≤6 cm
• Rate: 100–120/min
• Ratio: 30:2
• AED: Adult pads; energy 150–360 J (biphasic) or per device
• Hand position: Lower half of sternum

Child (1–8 years):

• Compression depth: About 5 cm (one-third AP diameter)
• Rate: 100–120/min
• Ratio: 30:2 (single rescuer); 15:2 (two healthcare rescuers)
• AED: Paediatric pads if available (reduce energy); if not, use adult AED
• Hand position: Lower half of sternum (one or two hands)

Infant (<1 year):

• Compression depth: About 4 cm (one-third AP diameter)
• Rate: 100–120/min
• Ratio: 30:2 (single rescuer); 15:2 (two rescuers)
• AED: Paediatric pads if available; if not, consider manual defibrillation rather than adult AED
• Hand position: Two fingers (single rescuer); two thumb-encircling hands (two rescuers)
• Location: Just below nipple line on sternum

Newborn (birth to 28 days)::

• Compression depth: About one-third AP diameter
• Rate: 90/min
• Ratio: 3:1 (C:T)
• Ventilation most important initially (most arrests in newborns are from respiratory causes)

3. Foreign Body Airway Obstruction (Choking)

Recognition — Conscious Adult:

• Can’t speak, cough, or breathe
• Universal sign (clutching neck)
• High-pitched sounds (stridor) or silent
• May become cyanotic

Management — Conscious Patient:

1. If coughing effectively — Encourage continued coughing; do NOT interfere
2. If coughing is ineffective or silent — Back blows (5) → Heimlich manoeuvre (5) → Alternate until dislodged or patient becomes unconscious

Heimlich Manoeuvre (Abdominal Thrusts):

• Stand behind patient; wrap arms around waist
• Make a fist above navel; cover with other hand
• Give 5 quick upward thrusts
• For obese or pregnant patients: Chest thrusts (same position but at mid-sternum)

Management — Unconscious Patient:

1. Lower to ground safely
2. Call for help and AED
3. Start CPR (30:2) — each time before delivering breaths, look in mouth for visible object
4. If object visible, remove with finger sweep
5. Continue CPR until object removed or help arrives

4. Automated External Defibrillator (AED)

When to Use:

• Unconscious, unresponsive, not breathing normally
• No carotid pulse (or uncertain pulse within 10 seconds)
• Patient is over 8 years old and 25 kg or more (paediatric pads for 1–8 years if available)

Steps:

1. Power on AED (voice prompts begin immediately)
2. Attach pads (one below right clavicle; one at left axilla — AP or lateral position)
3. Clear patient while AED analyses — DO NOT touch patient
4. If shock advised: Ensure all clear; deliver shock
5. Immediately resume CPR for 2 minutes
6. Repeat analysis cycle every 2 minutes

AED Pad Placement — Special Situations:

• Wet patient: Dry chest before applying pads
• Hairy chest: Shave if possible (razor should be in AED kit); if not, apply pads firmly
• Implanted pacemaker/ICD: Place pad at least 2.5 cm away from device
• Medication patches: Remove patch and wipe area before applying pad
• Jewellery/Metal: Move out of way; do not put pad directly over metal

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🔴 Extended — Deep Study (3mo+)

Comprehensive coverage for students on a longer study timeline.

5. The UAE Legal and Regulatory Framework for Resuscitation

A. Do Not Attempt Resuscitation (DNAR) Orders

• UAE Federal Law respects patients’ right to refuse or limit treatment
• A valid DNAR order must be: Written, signed by the patient (or legal surrogate if patient lacks capacity), witnessed, and dated
• Scope: May be limited to “no intubation” or “no CPR” — understand exactly what the order covers
• In the absence of a valid DNAR order, healthcare providers are legally and ethically obligated to attempt resuscitation
• DNAR orders must be reviewed regularly and updated as the patient’s condition changes

B. Advance Healthcare Directive (Living Will)

• In the UAE, the Dubai Health Authority and Abu Dhabi Department of Health support advance directive frameworks
• These documents outline a patient’s wishes for future medical care if they lose decision-making capacity
• Nurses may encounter these documents and must understand their legal standing

C. Family Presence During Resuscitation

• Many UAE hospitals have policies permitting family presence during resuscitation
• Studies show this can aid in the grieving process and does not impair resuscitation quality
• If family members are present, assign a staff member to support them and explain what is happening

6. Post-Cardiac Arrest Care (Post-Resuscitation Syndrome)

After successful resuscitation, patients require intensive care:

A. Haemodynamic Support

• Maintain MAP ≥ 65 mmHg (adequate cerebral perfusion)
• Vasopressors/inotropes: Adrenaline, noradrenaline, dobutamine
• Treat arrhythmias aggressively

B. Targeted Temperature Management (TTM)

• Formerly known as therapeutic hypothermia
• AHA and UAE ICU protocols recommend: Maintain temperature 32–36°C for 24 hours
• Indication: Comatose patients after ROSC (return of spontaneous circulation)
• Methods: Ice-cold IV fluids, cooling blankets, gel pads, intravascular cooling catheters
• Important: Prevent shivering (counteracts the therapeutic effect; use sedation, paralytics if needed)
• Rewarm slowly: 0.25–0.5°C per hour

C. Neurological Care

• Monitor GCS/AVPU regularly
• Prevent secondary brain injury: Maintain oxygenation, normocapnia, normoglycaemia
• Seizure control: Continuous EEG monitoring in comatose patients
• Neuroprognostication: Clinical examination, EEG, SSEP, neuroimaging — performed after rewarming and adequate sedation washout (typically 72+ hours)

D. Respiratory Support

• Mechanical ventilation: Target SpO₂ 94–98% (not 100% — hyperoxia is harmful post-cardiac arrest)
• Target PaCO₂: Normal (35–45 mmHg)
• Wean from ventilation as patient neurologically improves

E. Common Post-ROSC Complications

• Pulmonary oedema (from fluid overload, left ventricular failure, neurogenic pulmonary oedema)
• Arrhythmias (reperfusion arrhythmias are common)
• Acute kidney injury (from hypoperfusion, rhabdomyolysis)
• DIC (disseminated intravascular coagulation)
• Infection (ventilator-associated pneumonia)

7. Special Resuscitation Scenarios

A. Hypothermia

• Patients in cold water immersion or cold environment
• Do NOT declare death until patient is fully warmed (at least 32°C)
• Start CPR; continue during transport
• Use warm IV fluids; consider cardiopulmonary bypass in severe cases
• Ventilate with warm, humidified oxygen

B. Drowning

• Remove from water immediately; begin CPR on land or boat
• A-B-C priorities: A (Airway with C-spine protection) is especially critical — water in airways
• Do NOT attempt to drain water from lungs (it doesn’t work and wastes time)
• Hypothermia is common in drowning; treat accordingly
• Adrenaline is given after 2 minutes of CPR (or per ACLS protocol)

C. Electric Shock

• Before touching the patient: Ensure power source is disconnected
• Burns at entry and exit points indicate passage of current through body
• Assess for cardiac arrhythmias (VF and asystole are common)
• Monitor for internal burns (muscle necrosis can cause acute kidney injury from myoglobinuria)

Exam Watch: The most commonly tested DOH BLS question involves a patient who collapses and the nurse must decide whether to start CPR. The answer is ALWAYS: check responsiveness, call for help, check carotid pulse for no more than 10 seconds, and if no pulse, start CPR immediately. Delays in starting CPR are the most dangerous errors in cardiac arrest management.

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