Airway management, basic life support and external defibrillation — FAQ End-Point Assessment Health & Social Care Revision
This element focuses on the systematic assessment and management of a patient’s airway, including recognition of obstruction and appropriate interventions,
Topic Synopsis
This element focuses on the systematic assessment and management of a patient’s airway, including recognition of obstruction and appropriate interventions, along with the delivery of basic life support and safe use of an automated external defibrillator (AED) in pre-hospital emergency care. It emphasises practical competence in resuscitation techniques, understanding of choking algorithms, and post-resuscitation procedures, while also addressing special circumstances such as paediatric, trauma, or pregnancy-related cardiac arrest.
Key Concepts & Core Principles
- ABCDE assessment: A systematic approach to assessing and managing critically ill patients, prioritizing airway, breathing, circulation, disability, and exposure.
- Basic Life Support (BLS): Includes chest compressions, rescue breaths, and use of an automated external defibrillator (AED) for cardiac arrest patients.
- Clinical governance: Ensuring safe practice through audit, risk management, and adherence to protocols like the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.
- Patient handover: Using structured tools like SBAR (Situation, Background, Assessment, Recommendation) to communicate effectively with hospital staff.
- Infection prevention and control: Standard precautions such as hand hygiene, PPE use, and safe disposal of clinical waste to minimize cross-infection.
Exam Tips & Revision Strategies
- In practical exams, verbalise your actions clearly as you perform them, including safety checks and rationale, since assessors cannot read your thought process.
- Revise the current Resuscitation Council UK guidelines for BLS and choking specifically for both adult and paediatric patients, as algorithms are frequently updated and form the basis of assessment.
- When demonstrating AED use, always state ‘stand clear’ and visually check before delivering shock, and rehearse the seamless switch between CPR and defibrillation to minimise hands-off time.
- For written or questioning sessions, be prepared to explain how you would manage special circumstances such as drowning, hypothermia, or pregnancy, and cite specific modifications (e.g., longer CPR in hypothermia, left lateral displacement in pregnancy).
Common Misconceptions & Mistakes to Avoid
- Failing to open the airway fully before assessing breathing, leading to missed agonal gasps or partial obstruction.
- Performing abdominal thrusts on a choking patient who can cough effectively, instead of encouraging coughing, which escalates to an invasive intervention prematurely.
- Incorrect hand placement for chest compressions, often too low on the xiphoid process, risking injury and ineffective compressions.
- Leaving the AED connected and charging during rhythm analysis without ensuring everyone is clear, or attaching pads over medication patches or pacemaker sites.
- Omitting post-resuscitation monitoring, such as checking breathing and pulse regularly, or leaving the patient supine instead of recovery position when airway is at risk.
- Applying adult BLS protocols to a child without adapting to the paediatric modification (15:2 ratio with two rescuers, using one hand for infants, etc.).
Examiner Marking Points
- Award credit for demonstrating a structured airway assessment using look, listen, and feel, with clear documentation of findings and appropriate escalation.
- Credit must be given for correctly performing head tilt-chin lift or jaw thrust manoeuvre, selecting and inserting an oropharyngeal or nasopharyngeal airway adjunct if indicated, and stating contraindications.
- For a responsive choking patient, assessor must observe effective back blows and abdominal thrusts following current Resuscitation Council UK guidelines, including safety checks and reassessment.
- During basic life support assessment, the candidate must show effective chest compressions at the correct rate (100-120/min) and depth (5-6cm) with minimal interruptions, and provide rescue breaths using a pocket mask or bag-valve-mask device if competent.
- Evidence of safe AED use includes correct pad placement, following voice prompts, ensuring no one touches the patient during analysis and shock delivery, and attaching pads to a dry chest.
- Post-resuscitation care should include placing the patient in the recovery position (if breathing normally), monitoring vital signs, and preparing handover information to clinical team.
- For special circumstances, award credit if the candidate adjusts their approach for traumatic arrest (e.g., consideration of c-spine immobilisation), paediatric modifications (e.g., ratio of compressions to ventilations, smaller adjuncts), or pregnancy (manual uterine displacement).