1.2f Resuscitation (ALS & BLS) Flashcards
What is BLS? What is ALS?
https://resus.org.au
BLS
- Airway
- Breathing
- Cardiac compressions
ALS
- BLS
- Defibrillator
- Advanced airway management
- IV access and drugs
What is the BLS algorithm?
DRSABCD.
What is the correct location, depth, rate and ratio for chest compressions?
- 100-120BPM
- 5cm depth in chest
- Lower half of sternum
30:2 compressions to ventilation, until intubation.
What are the only times you should cease compressions?
To deliver shocks or breaths if the patient is not intubated.
When should you commence CPR?
Unresponsive and not breathing or agonal breathing is enough of an indication to commence CPR.
Absence of pulse should not be used as a sole indicator.
What is an indicator of good CPR occurring?
End tidal CO2 of 10-15mmHg is the best indicator.
Femoral pulse is not a good indicator, as you may be feeling the retrograde venous flow instead.
You should be able to see electrical activity during compressions.
What is an indicator that CPR has been successful and that there is return of spontaneous circulation?
- Eye opening, movement, spontaneous breathing
- Presence of central pulse, e.g. femoral pulse
What is the ALS algorithm?
See image.
Explain the next steps transitioning from BLS to ALS.
- CPR has been commenced. You now attach the defibrillator.
- Oxygen away, compressions continue.
- Charge defibrillator.
- Compressor’s hands off for evaluation of rhythm.
- Defibrillator evaluates rhythm, then will advise if shock advised/no shock advised.
If shockable, i.e. VT/VF, then deliver shock.
If non-shockable, continue BLS.
Explain the steps if the rhythm is assessed as shockable.
- Deliver shock - 200J biphasic, 360J monophasic.
- Continue CPR for 2 minutes, even after organised electrical activity, as there may not be enough for adequate output.
If ROSC:
- Stop CPR if there are signs of life, e.g. pulse, breathing, movement.
If No ROSC:
- Rhythm check after the 2-minute mark, then deliver shock, continue CPR
- From here:
- Deliver 1mg IV adrenaline after the 2nd shock and then every 2nd loop (1 loop is 2 min of CPR)
- Deliver 300mg IV amiodarone after the 3rd shock
i.e. rhythm check every 2 minutes, adrenaline every 4 minutes.
Explain the steps if the rhythm is assessed as non-shockable.
If the rhythm is non-shockable, give 1mg IV adrenaline immediately, then every 2nd rhythm check, i.e. every 4 minutes.
While compressions are occurring, what other ABCs could be occurring from an ALS perspective?
Airway
- Adjuncts (LMA, ETT)
Breathing
- Oxygen
- Waveform capnography
Circulation
- IV/IO access
Drugs
- Adrenaline/amiodarone
Compare IV drugs used in shockable vs. non-shockable rhythms.
- Shockable
- Adrenaline 1 mg after second shock, then after every 2nd loop
- Amiodarone 300 mg after 3rd shock
- Can try 150 mg in second attempt if no response
- Non-shockable
- Adrenaline 1 mg immediately then every 2nd loop
How often should breaths occur once advanced airway is in place?
RR 6-10 per minute.
When should magnesium sulphate be used in resuscitation?
First-line in Torsades, don’t wait for shock.
Use 5mmol, then another 5mmol immediately if no response.
What are the reversible causes of cardiac arrest?
4H’s and 4T’s
What modifications need to occur in life support for pregnant patients?
After k = 20, the gravid uterus compresses the IVC in supine position. It’s important to prevent aorto-caval compression.
Use left lateral tilt and notify the obstetrics team, may require peri-mortem caesarean.
