A female student collapsed in front of the narrator while they were waiting for the lift at MSU. Many students panicked and surrounded the victim. The narrator should take the following steps: 1. Clear the area of people and check for any dangers or responsiveness. 2. If unresponsive, begin chest compressions and shout for someone to call 999 for help while bringing an AED. Perform CPR with 30 chest compressions and 2 breaths in a 5 minute cycle until help arrives. 3. Continue CPR until an AED is used, the victim revives, or rescuers need to switch due to fatigue. Monitor the victim's status every 2 minutes.

1. Scenario
On a beautiful wednesday morning, you are walking to the class at MSU. While waiting for the
lift, suddenly one female student collapsed in front of you. Many of the students started to panic
and surround the victim. Take appropriate action and manage this situation.
23 Steps in Basic Life Support
1. Check for danger - put patient on flat surface
2. Check for environment - clear the area from human/crowd
3. Check for responsiveness by tapping the patient's shoulder & say "Cik, cik are you ok,
are you alright?"
4. If not responsive, put pressure at the manubrium
5. Shout for help ..someone call 999 ..ask them to bring AED- point out specifically to
someone so that we can avoid the bystander effect. " You in a blue msu shirt, call
999!!!!"
6. CHECK carotid pulse & access breathing - see chest rise, hear breathing, all within 10
sec
7. If no breathing & no pulse, perform high quality chest compressions
8. Remove victim’s shirt
9. Locate patient’s lower half of sternum, in between the nipple lines
10. Put your hand with interlocked fingers (dominant hand in contact with patient’s chest) &
wrist in 90 degree position over the above mentioned area. Hold your arms straight with
your shoulders directly over your hands. Use both your arm strength and the strength of
your upper body to do effective chest compressions.
11. Start CPR 30 Compression 2 ventilation
12. Before giving 2 rescue breaths, check for airway patency : Head tilt chin lift
13. Pinch nose and seal the mouth/use mouthpiece if available
14. Give 2 rescue breaths while looking at symmetrical chest rise
15. After finishing with 1st cycle, immediately continue with next chest compression
16. Complete 5 cycles of CPR for 2 minutes
17. Check for circulation & breathing (see chest rise) every 2 minutes
18. If no breathing & pulse, continue CPR until AED arrives/patient revives or once the first
rescuer fatigue & change with second rescuer to continue CPR
19. If breathing & circulation present, put patient in recovery position (left lateral position)
20. If AED arrives, attach the pads & follow AED command
21. If shockable rhythm, shock & continue CPR immediately
22. If non shockable, resumes and asses every two minutes
23. Continue the cycle until ROSC/ further help

2. Good quality of chest compression
● Compression rate: Rate 100-120 minutes
● Compression depth: Depth at least 5cm and not more than 6cm (2 inch)
● Hand placement: 2 hands on the lower half of sternum
● Chest recoil: Allow full recoil of the chest after each compression
● Push hard and fast
● Minimizing interruptions: limit minimal interruptions in chest compressions to less than
10 seconds

4. Resuscitation of narrow complex tachyarrhythmia (unstable)
Scenario?
A 17-year-old male patient presented to the emergency department with sudden
onset of palpitations after drinking high caffeine preparations at the gym. He had
no relevant medical history or family history of sudden cardiac death. He denied
any use of regular medications, alcohol or illicit drugs.
On arrival, he was tachycardic and hemodynamically unstable.

5. Steps
1. Assess & secure ABC
2. Connect to cardiac monitor
3. Check for HASIA - positive - unstable
● Hypotension
● Altered mental status
● Signs of shock
● Ischemic chest pain/discomfort
● Acute heart failure
4. Synchronised cardioversion 50-100J
5. Consider sedation (midazolam) if time permits
6. Can consider giving adenosine
7. Give normal saline flush
8. If still not stable give a shock again
9. Prepare for IV adenosine 12mg
10.If not stable give a shock again
11.Prepare 150mg Amiodarone IV over 10 minutes