ERC Summary 24 Pages
Transcript of ERC Summary 24 Pages
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Summaryof the main
changes in theResuscitationGuidelines
EUROPEAN
RESUSCITATION
COUNCIL
ERC GUIDELINES 2010
2
Published by:European Resuscitation Council Secretariat vzw,Drie Eikenstraat 661 - BE 2650 Edegem - BelgiumWebsite: www.erc.eduEmail: [email protected]: +32 3 826 93 21
European Resuscitation Council 2010.
All rights reserved. We encourage you to send this document toother persons as a whole in order to disseminate the ERC Guidelines.No part o this publication may be reproduced, stored in a retrievalsystem, or transmitted in any orm or by any means, electronic,mechanical, photocopying, recording or otherwise or commercialpurposes, without the prior written permission o the ERC.Version1.2
Disclaimer: No responsibility is assumed by the authors and thepublisher or any injury and/or damage to persons or property as
a matter o products liability, negligence or otherwise, or rom anyuse or operation o any methods, products, instructions or ideascontained in the material herein.
E u r o p e a nR e s u s c i t a t i o n
C o u n c i lTo p r e s e r v e h u m a n l i e b y m a k i n g
high quality resuscitation available to allThe Network o National Resuscitation Councils
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Basic lie support
Changes in basic lie support (BLS) sincethe 2005 guidelines include:
Dispatchers should be trained to
interrogate callers with strict protocols
to elicit inormation. This inormation
should ocus on the recognition o
unresponsiveness and the quality o
breathing. In combination with unre-sponsiveness, absence o breathing or
any abnormality o breathing should
start a dispatch protocol or suspect-
ed cardiac arrest. The importance o
gasping as sign o cardiac arrest is
emphasised.
All rescuers, trained or not, should
provide chest compressions to victims
o cardiac arrest. A strong empha-
sis on delivering high quality chest
compressions remains essential. The
aim should be to push to a depth o
at least 5 cm at a rate o at least 100
compressions min-1, to allow ull chest
recoil, and to minimise interruptions
in chest compressions. Trained rescu-
ers should also provide ventilationswith a compressionventilation (CV)
ratio o 30:2. Telephone-guided chest
compression-only CPR is encouraged
or untrained rescuers.
The use o prompt/eedback devic-
es during CPR will enable immediate
eedback to rescuers and is encour-aged. The data stored in rescue equip-
ment can be used to monitor and
improve the quality o CPR perorm-
ance and provide eedback to pro-essional rescuers during debriefng
sessions.
Electrical therapies:automated external def-brillators, defbrillation,cardioversion and pacing
The most important changes in the 2010ERC Guidelines or electrical therapiesinclude:
The importance o early, uninter-
rupted chest compressions is empha-
sised throughout these guidelines.
Much greater emphasis on mini-
mising the duration o the pre-shock
and post-shock pauses; the continua-
tion o compressions during charging
o the defbrillator is recommended.
Immediate resumption o chest
compressions ollowing defbrillationis also emphasised; in combination
with continuation o compressions
during defbrillator charging, the
delivery o defbrillation should be
achievable with an interruption in
chest compressions o no more than 5
seconds.
Saety o the rescuer remains par-
amount, but there is recognition in
Summary o main changes since 2005 Guidelines
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Adult Basic Lie Support
Shout or help
Open airway
NOT BREATHING NORMALLY?
Call 112*
2 rescue breaths30 compressions
30 chest compressions
UNRESPONSIVE?
*or national emergency number
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Unresponsive?
Call or help
Send or go or AEDCall 112*
Open airway
Not breathing normally
CPR 30:2Until AED is attached
Shockadvised
No shockadvised
1 Shock
Immediately resume:
CPR 30:2
or 2 min
Immediately resume:
CPR 30:2
or 2 min
Continue until the victim starts
to wake up: to move, openseyes and to breathe normally
AED
assesses
rhythm
* or national emergency number
Automated External Defbrillation
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Collapsed/sickpatient
ShoutorHELP&assesspatient
AssessABCDE
Recognise&treat
Oxygen,monitoring,ivaccess
Callresuscitationteam
Iappropriate
Han
dovertoresuscitationteam
Callresuscitationteam
CPR30:2
withoxygenandairwayadjuncts
Applypads/monitor
Attemptdefbrillationiappropriate
AdvancedLieSupport
whenresuscitationteamarrives
InHospitalR
esuscitation
No
Yes
Signso
lie?
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AssessusingtheABCDEapproach
EnsureoxygengivenandobtainIVaccess
MonitorECG,B
P,SpO2,record12leadECG
Identiyandtreatreversiblecauses(e.g.e
lectrolyteabnormalities)
NarrowQRS
Isrhythmr
egular?
Usevagalmanoeuvres
Adenosine6mgrapidIVb
olus;
iunsuccessulgive12mg
;
iunsuccessulgiveurthe
r12mg.
MonitorECGcontinuously
Normalsinusrhythmr
estored?
Possibleatrialutter
Controlrate(e.g.
-Bloc
ker)
Probablere-entryPSVT:
Record12-leadECGinsinus
rhythm
Irecurs,g
iveadenosineaga
in&
considerchoiceoanti-arrh
ythmic
prophylaxis
IrregularNarrowComple
x
Tachycardia
Probableatrialfbrillation
Controlratewith:
-Blockerordiltiazem
Considerdigoxinoram
iodaronei
evidenceoheartailure
Anticoagulateiduration
>48h
Assessorevidenceo
adversesigns
1.
Shock
2.Syncope
3.
Myocardialischaemia
4.Heartailure
Synchronise
dDCShock*
Upto3
attempts
Tachycardia(withpulse)
Amiodarone300m
gIVover
10-20minandrepeatshock;
ollowedby:
Amiodarone900m
gover24h
BroadQRS
Is
QRSregular?
Possibilitiesinclude:
AFwithbundlebranchblock
treatasornarrowcomplex
Pre-excitedAF
consideramiodarone
PolymorphicVT
(e.g.torsadesdepointes-
givemagnesium2
gover10min)
IVentricularTachycardia
(oruncertainrhythm):
Amiodarone300mgIVover20-6
0
min;then900mgover24h
Ipreviouslyconfrmed
SVTwithbundlebranchblock:
Giveadenosineasorregular
narrowcomplextachycardia
*Attemptedelectricalcardioversionisalwaysundertakenundersedationor
generalanaesthesia
See
kexperthelp
Yes
No
Unstable
Irregular
Regular
Narrow
Broad
Stable
Regular
Irregular
IsQRSnarrow(0
.12sec)?
Seekexperthelp
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Assess using the ABCDE approach
Ensure oxygen given and obtain IV access
Monitor ECG, BP, SpO2
,record 12 lead ECG
Identiy and treat reversible causes (e.g. electrolyte abnormalities)
Risk o asystole?
Recent asystole
Mbitz II AV block Complete heart block with broad QRS
Ventricular pause% 3s
Atropine500 mcg IV
Satisactory
Response?
Assess or evidence o adverse signs:
1 Shock
2 Syncope
3 Myocardial ischaemia
4 Heart ailure
Interim measures:
Atropine 500 mcg IV repeatto maximum o 3 mg
Isoprenaline 5 mcg min-1
Adrenaline 2-10 mcgmin-1
Alternative drugs*OR Transcutaneous pacing
* Alternatives include: Aminophylline
Dopamine
Glucagon (i beta-blocker or calcium channelblocker overdose)
Glycopyrrolate can be used instead o atropine
Bradycardia
Seek expert help
Arrange transvenous pacing
Yes No
Observe
No
No
Yes
Yes
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Unresponsive?
Not breathing or only occasional gasps
Call Resuscitation
Team
(1 min CPR frst, ialone)
CPR (5 initial breaths then 15:2)
Attach defbrillator/monitor
Minimise interruptions
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock 4 J/Kg
Immediately resume:CPR or 2 min
Minimise interruptions
Immediately resume:CPR or 2 min
Minimise interruptions
Return o
spontaneous
circulation
Assess
rhythm
During CPR
Ensure high-quality CPR: rate, depth, recoil Plan actions beore interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenaline every 3-5 min
Consider advanced airway and capnography Continuous chevvst compressions when advanced airway
in place Correct reversible causes
Reversible causes Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia
Tension pneumothorax Toxins Tamponade - cardiac Thromboembolism
Immediate post cardiacarrest treatment
Use ABCDE approach Controlled oxygenation andventilation
Investigations Treat precipitating cause Temperature control Therapeutic hypothermia?
Paediatric Advanced Lie Support
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Dry the baby
Remove any wet towels and coverStart the clock or note the time
I gasping or not breathing
Open the airwayGive 5 ination breaths
Consider SpO2 monitoring
I chest not moving
Recheck head position
Consider two-person airway controlor other airway manoeuvres
Repeat ination breathsConsider SpO2 monitoring
Look or a response
Reassess heart rate
every 30 secondsI the heart rate is not detectable or slow (# 60)
Consider venous access and drugs
I no increase in heart rate
Look or chest movement
When the chest is moving
I the heart rate is not detectable or slow (# 60)
Start chest compressions3 compressions to each breath
Newborn Lie Support
AT
ALLSTAGESASK:
DOYOUNEEDHEL
P?
Acceptable*
pre-ductal SpO2
2 min : 60%
3 min : 70%
4 min : 80%
5 min : 85%
10 min : 90%
Assess (tone),breathing and heart rate
30 sec
60 sec
Birth
Re-assess
I no increase in heart rate
Look or chest movement
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Become a member o the ERCYou can choose between
* Full membership on paper and electronic
* Full membership electronic version only
Full members on paper and electronic ( 140 or 12 months) enjoy:
- a subscription to Resuscitation, the ocial Journal o the ERC
- online access to Resuscitation (including all previous issues)
- reduction in the ERC-shop
- special registration rates at ERC congresses
Full members electronic version only ( 115 or 12 months) enjoy:
- online access to Resuscitation (including all previous issues)
- reduction in the ERC-shop
- special registration rates at ERC congresses
These benefts add to all the benefts you experienced as a web member:
- participate in ERC orums
- download items rom libraries
- stay updated with our ERC News Letter
IMPORTANT
ERC currently oers combined membership possibilities with a number o
organisations, with an additional discount: Belgian Resuscitation Council,
Norwegian Resuscitation Council, Resuscitation Council UK.
I you are already a member o one o these organisations, please contact
their secretariat or additional inormation about combined membership
possibilities.
www.erc.edu
www.CPRguidelines.eu