Cardiac Arrest in the Office: Basic Life Support

No HOF professional wants to think about cardiac arrest in their own office. The chance of it happening is very small, and aesthetic procedures are usually done on healthy people. But not thinking about it means reaching the worst hour of the day unprepared. In an arrest, the time between collapse and the first compressions is decisive, and what is done in the first minutes, before the emergency service arrives, is in the hands of whoever is in the room.

This page presents the concepts of basic life support in review language. It does not replace a hands-on basic (or advanced) life support course with a manikin and a certified instructor, or the current guidelines of the medical societies. There are no drug doses or advanced protocols here. For the full set of office resources, see emergency kit for the HOF office, AED in the HOF office and oxygen in the HOF office.

What is the chain of survival?

The chain of survival is the sequence of actions that raises the chances of recovery when someone has an arrest. Each link depends on the previous one, and the weakest determines the strength of the whole. In broad terms:

1. Recognition and activation of the emergency service. Realizing there is an emergency and calling for help right away.
2. High-quality chest compressions. Keeping circulation going until the defibrillator and the team arrive.
3. Early defibrillation. Using the AED as soon as it is available, following the device's instructions.
4. Advanced life support. The emergency team, with drugs and advanced airway management.
5. Post-arrest care. Hospital supportive treatment and investigation of the cause.
6. Recovery. Physical and emotional rehabilitation, including support for those who witnessed the event.

In the office, the focus is on the first three links: recognize, compress and defibrillate. The rest is the emergency service's responsibility.

How to recognize it

A typical arrest presents with:

• Unconsciousness: the patient does not respond to calling or touch.
• No normal breathing: no effective breathing movement, or only agonal breathing (irregular, noisy gasps that must not be mistaken for normal breathing).
• No signs of circulation, such as a pulse, which laypeople cannot always assess well. That is why the guidelines stress acting on anyone who is unconscious and not breathing normally.

Before reaching that point, several conditions can mimic or precede an arrest: fainting from a drop in blood pressure, seizure, hypoglycemia, severe allergic reaction. See vasovagal syncope in the office, anaphylaxis in the HOF office, seizure in the office and hypoglycemia in the office. The difference between them can be hard to tell, and when in doubt, with unconsciousness and no normal breathing, treat it as an arrest.

Basic life support step by step, in overview

The steps below summarize the reasoning of the guidelines and must be learned in a hands-on course.

1. Safety. Make sure the scene is safe for you and for the patient.
2. Response. Call the patient and firmly tap the shoulders.
3. Call for help. Shout for help, activate the emergency service (in Brazil, the medical emergency number) and ask for the AED and the emergency kit. If you are alone, call the emergency service first, on speaker, and carry on.
4. Breathing. Watch the chest for a few seconds. If the patient is not breathing or is only gasping, act as for an arrest.
5. Compressions. Place the patient on a firm surface with the chest exposed and start compressions in the center of the chest, fast and hard, allowing the chest to fully recoil after each compression and keeping interruptions to a minimum. Rate and depth follow the current guidelines, taught in courses.
6. Ventilation. Those with training can combine compressions with ventilations, using barrier devices and, if available, oxygen. Those without training can give compressions only.
7. AED. As soon as it arrives, turn it on and follow the voice prompts; apply the pads as shown in the diagram, make everyone stand clear during analysis and the shock, and resume compressions immediately afterward.
8. Continuity. Keep the cycle going until the team arrives, the patient recovers or you are unable to continue.
9. Record. Note times and actions, and hand the information to the emergency team.

The role of the AED

The automated external defibrillator is a device designed for use by trained laypeople. It analyzes the heart rhythm and tells you, by voice, whether a shock is advised. Not every arrest is "shockable", and the device decides. Points of attention:

• Quick access: the AED must be in a visible, well-known place, not locked away.
• Periodic checks: battery, pads and expiration dates checked and logged.
• Suitable pads: if you see patients of different ages, confirm you have the matching supplies.
• Training: everyone should know how to turn the device on and follow the prompts.
• Legislation: check the local requirements for the service.

The checking routine is detailed in AED in the HOF office.

Dividing roles in a team

In an emergency, confusion is the worst enemy. Agree on roles in advance:

• Leader: coordinates, watches the time and makes decisions. Can be the responsible professional.
• Compressor: performs compressions and rotates in cycles.
• AED and oxygen lead: brings and operates the equipment.
• Emergency contact lead: makes the call, gives the address and opens the door.
• Recorder: notes times and actions.

In a solo office, the professional takes on several roles and must prioritize: call for help, compress, use the AED. It helps to have arranged a signal for backup with the building's front desk or a neighbor. See multidisciplinary team in HOF.

Prevention: screening and observation

The best emergency is the one that does not happen. Some preventive measures reduce the chance of serious problems:

• Careful medical history, paying attention to heart disease, medication use, allergies and previous episodes. See medical history in HOF and general contraindications in HOF.
• Care with anesthetics: dose, aspiration, observation and knowing the signs of toxicity. See local anesthesia in HOF: overview and heart disease and anesthetics with vasoconstrictor.
• Observation during the procedure: color, breathing, level of consciousness and complaints.
• Patients who have fasted for a long time or are anxious: higher risk of syncope. See anxious patient in the appointment.
• After the procedure: do not release right away someone who feels unwell.
• Chest pain, shortness of breath or sudden headache: take it seriously and activate the emergency service. See chest pain in the office and suspected stroke in the office.

After the event

Once the emergency has passed, some steps remain:

• Pass on the information to the emergency team, including drugs used, the time of collapse and actions taken.
• Record it in the patient record and keep a detailed account.
• Inform the family, with the support of whoever accompanies the patient.
• Check on the team: those who witnessed it may need emotional support.
• Review the protocol: what worked, what was missing, what should change.
• Report when applicable, according to the law and the rules of the professional council. See adverse event reporting.
• Handle external communication, with legal advice if needed.

In Harmy

Summary

Cardiac arrest in the office is rare, but it calls for preparation. Recognize it quickly, call for help, start compressions and use the AED. Train the team, keep the equipment checked, divide roles and run drills. This page is only a map: real learning comes from a hands-on basic life support course and from repetition.