Basic life support (CPR) for physiotherapists

1Recognising cardiac arrest and the chain of survival

Cardiac arrest = the heart stops pumping effectively: the person is unresponsive and has no normal breathing (no breathing, or only occasional gasps). Gasping is not normal breathing; start CPR. Brain damage begins within minutes, so every minute without CPR lowers the chance of survival.

Chain of survival (adult, outside hospital): call for help early → high-quality CPR → early defibrillation → advanced care → care after the arrest → recovery. In hospital, the first link is recognising deterioration early.

2Adult BLS: the steps

1. Safety: make sure the scene is safe for you and the patient.
2. Check response: tap the shoulders and shout "Are you all right?". Do not shake the neck.
3. Shout for help and get the emergency response going: in hospital, call the emergency (code) team; outside, call 108 (ambulance) or 112, put the phone on speaker; send someone for an AED.
4. Check breathing (and, if trained, the carotid pulse at the same time) for no more than 10 seconds.
5. No normal breathing (no pulse): start chest compressions at once, then 30 compressions : 2 breaths.
6. When the AED arrives, switch it on and follow its voice prompts; restart compressions immediately after each shock.
7. Continue until the person starts breathing normally, the team takes over, or you are exhausted. Swap compressors every 2 minutes.

3High-quality CPR: the numbers

Compression-only CPR: untrained bystanders, or anyone unwilling or unable to give breaths, should give continuous hard and fast compressions in the centre of the chest until help arrives. This is the basis of the Indian compression-only life support (COLS) guideline for lay rescuers.

4Using an AED

1. Switch it on and follow the voice prompts.
2. Bare and dry the chest. Pads: one below the right collarbone, the other on the left side of the chest below the armpit (follow the pictures on the pads); not over a pacemaker bump.
3. Stand clear while it analyses; nobody touches the patient.
4. If a shock is advised: say "Stand clear", check, press the shock button.
5. Restart compressions immediately for 2 minutes; do not wait to check the pulse. The AED reanalyses every 2 minutes.

Defibrillation works for ventricular fibrillation and pulseless ventricular tachycardia; each minute of delay lowers survival, which is why AEDs are placed in public places and wards.

5Children and infants (outline)

Children usually arrest because of a breathing problem, so breaths matter more than in adults.

6Choking (airway obstruction by a foreign body)

• Mild (can cough, speak, breathe): encourage coughing; stay with them.
• Severe (cannot speak, breathe or cough; hands at the throat) in an adult or child: 5 back blows between the shoulder blades with the person leaning forward, then 5 abdominal thrusts (inward and upward, above the navel); keep alternating until the object comes out or the person becomes unresponsive (2025 AHA update adds back blows to abdominal thrusts).
• Pregnant or very obese: chest thrusts instead of abdominal thrusts.
• Infant: 5 back blows with the baby face-down along your forearm, then 5 chest thrusts; no abdominal thrusts.
• Becomes unresponsive: lower to the floor, call for help, start CPR; look in the mouth before giving breaths and remove a visible object (no blind finger sweeps).

7Recovery position

For a person who is unresponsive but breathing normally (and has no suspected spinal injury): roll them onto their side, upper leg bent at hip and knee in front for stability, hand under the cheek, head tilted back slightly so the airway stays open and vomit can drain. Keep checking breathing; if it stops, roll back and start CPR.

8Cardiac arrest in physiotherapy settings

• Be ready: know where the AED and emergency trolley are, the emergency number, and who in the gym is trained; keep a phone at hand during cardiac and pulmonary rehab.
• Warning signs before an arrest: chest pain, sudden breathlessness, dizziness, pallor and sweating, a new irregular pulse, falling BP: stop exercise, sit or lie the patient down, check vital signs and call for help early.
• On a monitor (ICU, cardiac rehab): ventricular fibrillation on the screen with an unresponsive patient means arrest: call, start CPR, defibrillate. A loose ECG lead also looks chaotic, so check the patient.
• After heart surgery: follow the unit's protocol (some units shock or re-open the chest first), but never withhold compressions out of fear of the sternal wound.
• Do-not-resuscitate orders: check the patient's documented wishes in advance.
• Training: BLS certificates usually last 2 years; practise on a manikin with feedback.

9Exam corner

Not asked in the theory papers from 2016 to 2026. In the practical exam, BLS can be asked as a skill demonstration and in the viva.