Advanced Cardiac Resuscitation Guidelines

By

Muhammad Bayat

BLS- HAZARDS

• Hazards- Make sure the scene is safe for you to help.

Make sure you have universal precautions: gloves, Face Mask, and Apron

BLS- HELLO + HELP

• Determine if the patient is conscious by tapping and shouting "Are you OK?" If no response have someone call for the crash cart

BLS- Airway

• Position the patient on their back. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver.

• Suction the airway and clear out any foreign bodies

• Insert an appropriate sized Guedel airway

BLS - Breathing

• LOOK-LISTEN-&-FEELING for breaths

• CHECK REATHING FOR 5-10 SECONDS.

• If they isn’t breathing VENTILATE TWICE -Rescue Breathing

BLS- Circulation Check

• Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.

BLS- Circulation

• If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS for both one and two man CPR

BLS - CPR

• Recheck the pulse after ONE MINUTE. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE. Approximately 4 cycles will pass before the pulse check

Advanced Life Support

• Recommended Minimum Equipment for the Management of Adult Cardiopulmonary Arrest

AIRWAY EQUIPMENT • Self inflating resuscitation bag with oxygen

reservoir and tubing -BVM• Laryngoscopes x 2 - normal and long blades • Spare laryngoscope bulbs and batteries

ALS AIRWAY EQUIPMENT

• 1" ribbon gauze/tape

• Scissors

• Syringe - 20 mls

• Oxygen cylinders x 2 (if no wall oxygen)

• KY Jelly

ALS - Equipment

CIRCULATION EQUIPMENT

• Intravenous cannulae 18 gauge x 3, 14 gauge x 3

• Hypodermic needles 21 gauge x 10

• Syringes 2 mls x 6, 5 mls x 6, 10 mls x 6, 20 mls x 6

• Intravenous giving sets

• IV Infusion Fluid- MRL

Basic ALS Drugs

• DRUGS

• Adrenaline / Epinephrine 1 mg (1:1000)

• Atropine 3 mgs

• Amiodarone 300mgs

• Phenergan

• Hydrocortisone

• Lignocaine

ALS - Additional Equipment

ADDITIONAL ITEMS

• ECG Electrodes

• Defibrillation Gel pads

• Pulse Oximeter

• Gloves/Goggles/Aprons

• NIBP Monitor

ALS- Management

Heart rhythms associated with cardiac arrest

can be divided into two groups:

1.) ventricular fibrillation / pulseless

ventricular tachycardia (VF/VT)

2.)Other rhythms. Asystole and pulseless

electrical activity (PEA).

ALS -Rhythm

Why the Differentiation?

• The management of these two groups of arrhythmias is different

• Defibrillation in those patients with VF/VT

• Drugs used in the other rhythms

ALS- Rhythm Recognition

Similarities

• CPR , Airway management and Ventilation, venous access, the administration of epinephrine (adrenaline) and the identification and correction of contributing factors, are common to both groups.

ECG RHYTHMN REGONITION

• Ventricular Fibrillation

• Asystole

ALS- Defibrillation

• Turn on the Machine

• Change Lead Select

• Gel the Paddles

• Confirm the Rhythm

• Set Energy level at

• 200J

• 3 stacked defibrillation of 200,200,360J

ALS- Advanced Airway

• Prepare Equipment• Insert Airway• Check Position• Ventilate• Consider Surgical

Airway -Cricothyroidotomy

ALS- Drug Therapy

VENTRICULAR FIBRILLATION

Adrenaline

• Dilute 1mg of 1:1000 adrenaline into 10mls

• Give 1mg every 3minutes followed by a stacked shock after 1 minute of CPR

• Maximum dose = 3mg

ALS- Drug Therapy

Atropine

• Used in Asystole and PEA

• Mech.. Of Action : Vagolytic Drug

• Given at a dose of 1mg every 3 minutes till a maximum of 3mg

ALS- Drug Therapy

Amiodarione

• Used in persistent VF that remains despite adrenaline

• Used post 2nd defibrillation attempt

• 300mgf bolus given mixed with 20ml of dextrose

Anaphylaxis

Clinical Features• Urticaria (hives)

and/or angioedema• Hypotension -Shock• Upper Resp Tract

Obstruction.• Bronchospasm• Cyanosis

Anaphylaxis-Treatment

• Prevention

• ALS- Airway Protection,Breathing, Circulation

• Adrenaline (0.5ml IMI & Nebulised & IV)

• Antihistamines (Promethazine 25mg)

• Adrenergic Agonists (Salbutamol Nebs)

• Hydrocortisone (200mg IVI)

ALS- Take Home Message

• Do Not Panic

• Remember ABC’s

• Defibrillate only a VF/VT & remember the GEL

• Adrenaline is common drug to all the protocols