ST EMLYN’S · MLA REVISION GUIDE
Resuscitation
01 / CHAPTER 8
Recognise deterioration and begin effective care
Resuscitation brings clinical assessment, practical action and communication together. Your task as a student approaching graduation is to recognise a critically ill person, begin appropriate immediate care, obtain the right help and contribute effectively to the team. A simulated station may ask you to coordinate the initial response, but this does not imply that you should independently undertake the work of a senior emergency physician in clinical practice.
Read the role and task carefully. You might be the first person to assess a deteriorating patient, a team member delivering a defined intervention, or a student asked to explain your priorities. In each case, show what you recognise, what needs to happen now and what requires additional expertise. Calling for help is an action with a purpose: specify the problem, exact location and required response, and continue the care you can provide safely while help is coming.
Practise in varied settings. The first response to collapse in a GP waiting room, deterioration on a ward, an unwell child or an obstetric emergency shares some principles but differs in the people, equipment and specialist pathways available. Use your medical school’s resuscitation teaching and current local protocols. GMC Outcomes for graduates places recognition of acute illness and emergency care within the capabilities expected at graduation.
The team–environment–equipment framework helps you prepare. Its purpose is to make the next action possible, not to delay care while you recite a list. An unconscious person who is not breathing normally needs a cardiac-arrest response; they do not need you to finish a routine history first.
02 / CHAPTER 8
Assess, act and reassess
For a deteriorating patient with signs of life, use ABCDE: airway, breathing, circulation, disability and exposure. Treat an immediate threat as you find it and check the response. Tasks can happen together when team members are available. In trauma, catastrophic external haemorrhage may need immediate control before the rest of the sequence. The structure supports your judgement; it should never become a reason to ignore a visible emergency.
| Stage | What you need to establish |
|---|---|
| Airway | Is air moving freely? Listen for obstruction and assess whether the patient can speak. Use trained airway-opening measures and obtain urgent help for obstruction. |
| Breathing | Assess rate, effort, chest movement, oxygen saturation and oxygen delivery. Consider whether ventilation as well as oxygenation is failing. |
| Circulation | Assess pulse, blood pressure, peripheral perfusion and bleeding. Arrange monitoring and access while considering the cause of shock. |
| Disability | Assess consciousness, pupils and blood glucose, with a focused neurological assessment where needed. Treat a reversible cause through the appropriate protocol. |
| Exposure | Look for relevant injury, rash, bleeding or other clues, measure temperature and preserve dignity and warmth. |
RCUK’s ABCDE approach provides the full clinical sequence. Choose interventions for the patient and your competence, and use current protocols for oxygen targets, fluids and medicines.
Say what a finding means. “The patient is becoming drowsy and their breathing is ineffective; I need urgent airway support” communicates a priority. “Airway, breathing, circulation” without findings does not. After an intervention, report the change in physiology and symptoms. A temporarily improved number does not establish that the underlying problem is resolved.
Use an early-warning system appropriate to the patient group and local setting, but respond to clinical concern even when a score is not high. Listen to the patient, relatives and nursing staff: a change from the patient’s baseline may matter more than an isolated observation. The RCUK adult ALS guidance emphasises early recognition, structured handover and systems that allow staff to call for help on clinical concern.
03 / CHAPTER 8
Recognise cardiac arrest and use the right algorithm
Adult basic life support
If an adult is unresponsive, summon emergency help immediately and assess breathing. Outside hospital, call 999, using speakerphone if available; follow the local cardiac-arrest call process in hospital. Abnormal gasping is not normal breathing. If unresponsive with abnormal breathing, start CPR and obtain an AED promptly. Follow its prompts and ensure nobody touches the patient during analysis or a shock.
For adult CPR, compress at 100–120 per minute to a depth of 5–6 cm, allow recoil and minimise pauses. If trained to give breaths, use 30 compressions to 2 breaths, with enough air to produce chest rise. Resume compressions immediately after a shock or a no-shock instruction. Practise the technique on a manikin with feedback; knowing the numbers does not demonstrate effective compressions. See RCUK adult basic life support, 2025.
Working with the resuscitation team
Make your role clear and accept a task you can perform. Effective compressions, attaching monitoring, recording events, obtaining equipment and giving a concise handover all contribute to care. Confirm instructions and report completion or difficulty. Manual defibrillation, advanced airway management and resuscitation medicines require the relevant training and team oversight. Do not delay AED use while waiting for someone who can operate a manual defibrillator.
Learn to recognise shockable and non-shockable rhythms and understand the reversible causes considered during ALS. In a simulated discussion, explain the appropriate algorithm and treatment priorities. In clinical care, communicate a suspected cause to the team leader and undertake the agreed action. Decisions to stop resuscitation or to make complex treatment-limitation decisions are not independent student decisions.
Children and newborns
Paediatric resuscitation requires age-appropriate technique and equipment. RCUK 2025 advises checking responsiveness, summoning help, assessing breathing and giving five initial rescue breaths before compressions. Use 15:2 when specifically trained in paediatric BLS; otherwise use 30:2. Rehearse with your school’s practical teaching and the current paediatric life-support guidance.
Birth and transition require a newborn approach. Outside the delivery area, the choice between NLS and PLS depends on the setting, age, cause and local policy. Begin effective care using the team’s familiar approach, obtain neonatal or paediatric help and make any change of algorithm explicit. RCUK newborn guidance explains this distinction. Do not apply adult drug doses or equipment sizes to a child; use the current approved paediatric chart and check the relevant weight and dose limits.
04 / CHAPTER 8
Prepare and participate in the team
Introduce, share the problem and get help
Use your actual role: “I’m a medical student with the team. This patient has suddenly become unresponsive. Please put out the cardiac-arrest call and bring the resuscitation trolley.” In UK hospitals, 2222 is the standard cardiac-arrest number, but learn the local activation process and state the exact location. In community settings, activate emergency ambulance help through 999. Use the appropriate paediatric, obstetric, trauma or neonatal response when the situation requires it.
Listen to the handover and identify what has already happened. For trauma, ATMIST can structure age, time, mechanism, injuries, signs and treatment. For other deterioration, SBAR helps you communicate the situation, relevant background, assessment and request. Repeat the immediate priority and your allocated task so that the team knows what you are doing.
Prepare what the patient needs
| Area | Practical contribution and limits |
|---|---|
| Environment | Check safety, protective equipment, space, lighting and access. In chemical or environmental incidents, do not enter an unsafe area or become another casualty. |
| Airway and breathing | Locate oxygen, suction, masks, bag–valve–mask equipment and appropriate adjuncts. Only use unfamiliar equipment with trained help; an anaesthetic circuit is not interchangeable with a self-inflating bag. |
| Circulation | Prepare monitoring, a suitable cuff, access equipment and the defibrillator. Help activate the local major-haemorrhage pathway when requested. Check equipment and samples rather than merely naming them. |
| Disability and temperature | Make glucose testing, a pen torch, temperature measurement and appropriate warming available. |
| Medicines | Check identity, allergies, medicine, concentration, dose, route and timing with the authorised clinician. Do not independently prescribe or administer an unfamiliar emergency medicine. |
| Specialist equipment | Recognise why a team might request thoracostomy, thoracotomy, intubation, neonatal or resuscitative-hysterotomy equipment. These require a trained operator and an organised team; collecting a kit does not confer competence. |
For a child, help obtain the best available weight and current approved emergency chart. A mnemonic such as WETFLAG may organise preparation, but it does not validate a calculation or replace the chart. Ask a specific question if the dose or equipment size seems inconsistent, and confirm that the concern has been heard.
Communicate during changing care
Address a named colleague, make a specific request and listen for the response. If you are given a task, repeat it back when useful, perform it and report the result. If you cannot complete it, say so promptly: “I have not obtained access after this attempt; can someone more experienced take over?” This is more useful than silently persisting while treatment is delayed.
A scenario may include an error or conflict. If collapse follows local anaesthetic administration, identify the possible toxicity, stop further administration and alert the team. The specialist response includes treatment modifications set out in the Association of Anaesthetists’ local anaesthetic toxicity guidance. Preserve the relevant medicine and dose information for the team; blame and argument must not delay care. Return to Chapter 4 for candour and professional communication.
05 / CHAPTER 8
Handover, ongoing care and learning
The station may finish with improvement, transfer, continuing instability or cardiac arrest. Give a concise account of the initial problem, important findings, treatment and response, remaining risks and required next action. Make the transfer of responsibility explicit. Return of spontaneous circulation is the start of ongoing post-resuscitation care, not the end of the patient’s needs; continue monitoring and assessment with the appropriate team.
Keep the patient and relatives informed through an appropriate member of the team. Record key events, times, medicines, observations and decisions accurately. If something went wrong, tell the responsible clinician promptly and follow the reporting and candour process. The record should distinguish what you observed from what someone else reported.
After a simulation, discuss one clinical decision and one communication issue in enough detail to change the next attempt. For example, identify why you failed to notice ineffective breathing, or why a request for help was not acted on. Rehearse that part again with feedback. After a real event, seek support as well as learning; resuscitation can be distressing for staff, patients and families.
Practise an adult collapse, a deteriorating ward patient, a breathless child, a maternal emergency and a trauma presentation. Vary the setting and information available. These are useful learning contexts, not predictions of an examination circuit.
06 / CHAPTER 8
Current guidance and a scenario library
Begin with current national guidance and your medical school’s practical teaching. ALS, APLS/EPALS, NLS and trauma-course materials are useful educational sources, but possessing every postgraduate manual or undertaking every specialist course is not a universal MLA requirement. The directory below offers a broad range of practice scenarios. It is not a list of skills that a student is authorised to perform independently.
- RCUK adult basic life support
- RCUK adult advanced life support
- RCUK paediatric life support
- RCUK newborn life support
Use national algorithms for current recommendations and supplementary teaching for explanation. Advanced procedures such as thoracotomy, escharotomy and resuscitative hysterotomy are included to help you recognise why specialist help is needed and understand the team’s care. Chapter 9 distinguishes graduate practical skills from advanced procedures.
Choose one scenario family. Revise the current algorithm, rehearse your first actions, then add a communication challenge or unexpected deterioration. These are practice prompts, not a list of guaranteed examination stations.
Adult and obstetric emergencies
Cardiac arrest and arrhythmias
- RCUK — adult ALS and in-hospital resuscitation (2025)
- Adult bradyarrhythmia algorithm (2025 PDF)
- Adult tachyarrhythmia algorithm (March 2026 PDF)
- RCUK — post-resuscitation care
Medical emergencies
- Anaphylaxis: RCUK emergency treatment guidance.
- Acute asthma: BTS/NICE/SIGN acute asthma pathway; use its adult section.
- Cardiac emergencies, electrolyte disturbance and poisoning: RCUK special circumstances and TOXBASE (professional access/login required).
- Major gastrointestinal haemorrhage: upper GI bleeding and lower GI bleeding — RCEMLearning teaching, alongside the current local major-haemorrhage pathway.
Obstetric emergencies
- Eclampsia: NICE NG133 — hypertension in pregnancy.
- Emergency delivery and postpartum haemorrhage: NICE NG235 — intrapartum care and early obstetric/midwifery support.
- Maternal cardiac arrest and resuscitative hysterotomy: RCUK special circumstances (2025). Prepare early and follow the current guidance; do not treat a timing mnemonic as a reason to wait.
Additional teaching
St Mungo’s scenario notes: eclampsia, delivery, postpartum haemorrhage and hysterotomy. Use the national guidance above for current treatment and timing.
Paediatric and newborn emergencies
Basic life support, arrest, arrhythmias and choking
- RCUK — paediatric life support (2025)
- RCUK — paediatric algorithms and emergency resources (February 2026 PDF)
Anaphylaxis, asthma and electrolyte problems
- RCUK — emergency treatment of anaphylaxis (use the age-appropriate recommendations).
- BTS/NICE/SIGN — acute asthma in children and SORT — life-threatening asthma (regional critical-care guidance).
- RCUK paediatric life support and the endocrine/electrolyte section of PIER’s regional guidelines. Do not apply an adult electrolyte regimen to a child without the appropriate paediatric guidance.
Newborn resuscitation and neonatal collapse
Revise RCUK newborn life support for birth and transition. For an infant collapsing later, consider the setting, cause and local NLS/PLS policy. Teams should begin effective resuscitation using a familiar approach, call appropriate help and communicate any change of algorithm clearly.
For neonatal collapse, SCAMS prompts consideration of Sepsis, Cardiac disease, Abuse, Metabolic causes and Seizures. Also consider poisoning and other causes; the mnemonic is not an exhaustive differential.
- SORT — neonatal collapse, including congenital cardiac causes (July 2024; review due 2027)
- SORT — sepsis/shock quick reference (July 2024; review due 2027)
- NICE CG89 — recognising child maltreatment
- BIMDG — metabolic emergency guidance
- SORT — seizures (December 2024; review due 2027)
- TOXBASE — poisoning (professional access required)
SORT documents are regional guidance. Involve the local paediatric/neonatal team and retrieval service early; check the SORT guideline directory for current versions.
Trauma
Core guidance
- NICE NG39 — major trauma: assessment and initial management
- RCUK — traumatic peri-arrest and cardiac arrest (2025)
- PIER — Wessex children’s major trauma guidance
Use current ATLS/ETC course materials and your trauma network’s operational guidance. The former adult Wessex PDF has a 2021 amendment log; use the national recommendations and your current local protocol for clinical decisions.
Build a varied practice list
- Airway and major haemorrhage: rehearse the relevant NICE major-trauma recommendations and the local activation process.
- Head and spinal injury: NICE NG232 — head injury and NICE NG41 — spinal injury.
- Thoracic, abdominal and pelvic trauma: practise recognising immediate threats, proposing appropriate imaging and explaining the need for definitive care.
- Traumatic arrest and resuscitative thoracotomy: use current RCUK guidance and the trauma team’s procedure pathway.
- Trauma in pregnancy: combine trauma care with early obstetric support; use the pregnancy section of RCUK special circumstances if cardiac arrest occurs.
- Older people with trauma: consider frailty, comorbidity, medicines and apparently minor mechanisms alongside physiology and injury.
Additional teaching
Environmental emergencies and major incidents
Prepare for the exposure and the environment as well as the patient. Use RCUK special circumstances (2025) for resuscitation modifications in drowning, hypothermia, hyperthermia and poisoning.
Scenarios and supplementary teaching
- Burns and escharotomy: RCEMLearning — burns; St Mungo’s — escharotomy.
- Drowning: RCUK special circumstances.
- Electrical injuries: RCEMLearning.
- Hypothermia and hyperthermia: severe hypothermia and heat-related illness — RCEMLearning; check resuscitation changes against RCUK 2025.
- Altitude and diving: RCEMLearning — environmental emergencies.
- CBRN: industrial chemical incidents, radiation exposure and TOXBASE (professional access required).
- Blast injuries: RCEMLearning.
Major incidents
NHS England — clinical guidelines for major incidents (version 2, September 2020 PDF). This is the dated national resource linked by NHS England; pair it with your organisation’s current major-incident, triage and CBRN arrangements.