CPR and First Aid for Medical Assistants: Emergency Procedures

Your Role in Office Emergencies

Medical assistants are often the first person in a room with a patient who is deteriorating. You may be rooming a patient when they have a syncopal episode. You may be drawing blood when someone goes into anaphylaxis. Knowing what to do in the first 60 seconds matters more than any clinical skill you perform on a routine day.

Medical assistants do not act independently in emergencies. You work within a team, following protocols set by the supervising physician. But you need to know what those protocols require so you can act without hesitation while someone calls for help.

Basic Life Support: The Adult BLS Sequence

BLS training is required for most MA positions. The sequence for adults follows the CAB approach: Compressions, Airway, Breathing.

1. Check the scene for safety. Never rush in if the scene is unsafe. A second victim helps no one.
2. Check for responsiveness. Tap the patient's shoulders firmly and shout "Are you okay?" If no response, call for help.
3. Call 911 (or direct someone specific to call). Say "You — call 911 and come back." Bystander diffusion happens when everyone assumes someone else is calling. Name a specific person.
4. Check for a pulse and breathing simultaneously. Check the carotid pulse for no more than 10 seconds while scanning for normal breathing. If absent or uncertain, start CPR.
5. Begin chest compressions. Place the heel of your hand on the center of the chest (lower half of the sternum). Compress at least 2 inches deep at a rate of 100 to 120 compressions per minute. Allow full chest recoil between compressions. Minimize interruptions.
6. Deliver breaths. After 30 compressions, give 2 rescue breaths (30:2 ratio). Each breath should take about 1 second and produce visible chest rise. If unable or unwilling to give breaths, continuous hands-only CPR is acceptable for adult bystander response.
7. Use the AED as soon as it arrives. Turn it on, apply pads per the diagram, and follow all prompts. Analyze rhythm, deliver shock if advised, resume CPR immediately after the shock. Do not pause compressions any longer than necessary.

For infants and children, compression depth and ratio differ. Pediatric BLS is its own topic. Know that the adult sequence above applies to patients roughly puberty and older.

Choking: Conscious vs Unconscious Patient

Conscious adult with complete airway obstruction: The patient cannot cough, speak, or breathe effectively. They may have the universal choking sign (hands clutched to throat). Ask "Are you choking?" If they cannot respond verbally, act.

Stand behind the patient. Give 5 back blows between the shoulder blades using the heel of your hand. Then deliver 5 abdominal thrusts (Heimlich maneuver): position one fist above the navel and below the sternum, wrap the other hand around it, and thrust inward and upward. Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the patient loses consciousness.

For pregnant patients or those who are obese, use chest thrusts instead of abdominal thrusts — same position as CPR compressions but directed inward.

Unconscious choking patient: Lower them carefully to the ground. Call 911 if not done. Begin CPR. Each time you open the airway to give breaths, look into the mouth. If you can see the object, remove it with a finger sweep. Do not perform blind finger sweeps — you may push the object deeper.

Bleeding Control

Direct pressure is always the first intervention for external bleeding. Apply firm, continuous pressure with a gloved hand and gauze or cloth. Do not lift the material to check whether bleeding has stopped — this disrupts clot formation. Add more material on top if blood soaks through. Maintain pressure for at least 10 to 15 minutes for significant wounds.

Elevate the bleeding extremity above heart level if there is no suspected fracture. This reduces blood flow to the area through gravity.

A tourniquet is appropriate when direct pressure fails to control life-threatening extremity bleeding — a major arterial bleed that is not responding to pressure, for example. Apply 2 to 3 inches above the wound, tighten until bleeding stops, and document the time of application. Never remove a tourniquet once applied except under physician direction. Tourniquets cause tissue damage and their removal can cause cardiovascular collapse if not managed medically.

Shock: Recognition and Positioning

Shock is inadequate tissue perfusion. Early signs include restlessness, anxiety, pale and cool skin, rapid weak pulse, and moist or diaphoretic skin. As shock progresses, BP drops, level of consciousness deteriorates, and the patient may become unresponsive.

For hypovolemic or distributive shock (the most common types seen in a medical office — from bleeding, dehydration, or anaphylaxis), position the patient supine with the legs elevated 8 to 12 inches (the modified Trendelenburg or shock position). This promotes venous return to the heart. Do not use this position if head, neck, or spinal injury is suspected.

Keep the patient warm, monitor vital signs continuously, and administer oxygen per physician order. Do not give anything by mouth to a patient in shock.

Syncope

Syncope (fainting) is a temporary loss of consciousness from reduced cerebral blood flow. In a medical office it often happens during blood draws, injections, or while a patient is standing for extended periods.

If a patient feels faint (presyncope — dizziness, nausea, pallor, diaphoresis), have them lie down immediately. Elevate the legs. Loosen tight clothing. Provide cool, moist air. Most patients recover quickly in this position.

If a patient faints, lower them to the ground safely rather than letting them fall. Elevate the legs. Never leave a fainted patient alone. Check for a pulse and breathing. If present, allow them to recover lying down. Do not give them food or water until fully alert. If they do not recover within 1 to 2 minutes, treat as a cardiac event and begin BLS assessment.

Anaphylaxis

Anaphylaxis is a severe, life-threatening systemic allergic reaction. Signs develop rapidly after exposure to an allergen — often within minutes. Watch for hives, flushing, swelling of the face or throat, stridor (high-pitched breathing), wheezing, hypotension, tachycardia, and abdominal pain or vomiting.

Epinephrine is the first-line treatment. No antihistamine, no corticosteroid, no waiting to see if it gets better. Epinephrine — and fast.

Most offices stock epinephrine auto-injectors (such as an EpiPen). The MA's role, under physician direction or per standing orders, is to administer the auto-injector into the outer mid-thigh, hold for 10 seconds, and note the time. Call 911. The patient needs emergency transport even if they appear to improve — biphasic reactions can occur hours later.

Position the patient supine with legs elevated unless respiratory distress makes this intolerable (in that case, allow them to sit up). Administer oxygen. Monitor vitals continuously until EMS arrives.

The Office Crash Cart and Oxygen

Crash carts (or emergency supply kits) in medical offices vary, but typically contain: epinephrine, diphenhydramine, glucagon, nitroglycerin, aspirin, oxygen, airway management supplies (bag-valve mask, airways), IV supplies, AED, and emergency reference cards.

MAs may be responsible for maintaining the crash cart — checking expiration dates, restocking after use, and verifying the AED battery and pad status. Know where it is in your facility before you ever need it.

Oxygen administration at low flow rates (2–4 L/min via nasal cannula) is within MA scope in most states under physician direction. A bag-valve mask (BVM) delivers oxygen during CPR when supplemental O2 is available. Attach the oxygen tubing to the BVM reservoir and set flow to 10–15 L/min for BVM use.

Practice Questions