Adult BLS and ALS Flashcards
step 1 of BLS
- check for a response (to voice, to pain (trapezius squeeze)
response = start ABCDE
no response = call for help
what is the chain of survival
The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with cardiac arrest.
Early recognition and call for help
Early CPR
Early defibrillation
Early advanced cardiac life support
what do you do next if there is no response
- get help
- position pt on their back and inspect airway
- head-tilt chin lift
- Assess for signs of life
- carotid pulse
- assess breathing for 10 seconds (check RR)
what do you do if a pulse is present but the RR is low
If the respiration rate is below 12 – assist ventilation with bag valve mask (BVM) to maintain 10 breaths/min (re-checking the pulse every minute to ensure it is still present).
You will likely need two people to perform effective ventilation with a BVM (one ensuring a good seal over the face and the other compressing the bag to deliver the oxygen).
The BVM should ideally be connected to high-flow oxygen as soon as possible.
what do you do if a pulse is present and the RR is fine
urgent ABCDE to stabilise before further deterioration
what is agonal breathing
If the patient has occasional, irregular gasps of breath, this does not qualify as a sign of life as it commonly occurs in cardiac arrest and is referred to as agonal breathing.
what do you do if there is no signs of life?
call for help from resuscitation team and commence CPR
if you are alone, you should leave the patient and get help first
CPR ratios and speed asult
30 chest compressions followed by 2 ventilations
Perform compressions at approximately 100-120 compressions per minute.
how often should you alternate who is perfoming chest compressions
Alternate the person performing chest compressions at 2-minute intervals (if enough team members are present).
what do you do once AED arrives
Once an automated external defibrillator (AED) arrives, it is import to attach the 2 self-adhesive pads immediately to the patient’s chest (as labelled):
ADHESIVE PAD 1: the right of the sternum below the clavicle.
ADHESIVE PAD 2: the mid-axillary line, with its long axis vertical and sufficiently lateral.
when does advanced life support commence
once the resuscitation team arrives.
What is ALS?
ALS builds on BLS to increase liklihood of survival of cardiac arrest
it takes over from BLS once chest compressions have commenced and a defib is attached.
It focuses on more advanced airway management, adding in drugs for shockable and non-shockable rhythms and correcting reversible causes of cardiac arrest
what airway adjuncts may you use in ALS
oropharyngeal
nasopharyngeal
i-gel/LMA
endotracheal intubation
what defined roles are there in ALS
Team leader
Timer and scribe
Airway
CPR1/defib
CPR2
IV access/bloods/gases/Drugs
what rhythms are shockable rhythms
pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF)
what should the team leader do?
delegate tasks
ask people to say when theyve completed a task/cycle
coordiante tasks
go through reversible causes
in what circumstances should chest compressions be continuous
Chest compressions should be continuous once the airway is secured with endotracheal tube
under what circumstances/for what things do you pause compressions for
ONLY stop CPR for rhythm checks, electrical shocks, and the 2 rescue breaths. Ask the person doing compressions to tell the airway person each time 30 compressions are complete.
what do you do with defib if pt has a pacemaker?
if a pacemaker is present, ensure pads are >8cm away from it (you can put the pads on AP if needed)
what are the cycles of ALS, when do they start?
a cycle = 2 minutes of CPR/rescue breaths
Cycle 1 starts when the defibrillator is connected.
Perform a rhythm check ± shock every 2 minutes
Management of a shockable rhythm
2 minute cycles of cpr followed by rhythm check
If the initial rhythm is shockable, provide one shock (at the recommended joules for your equipment)
resume cycles
After the third shock, give 300mg amiodarone and 1mg adrenaline IV/IO
Continue adrenaline every 3-5min
After the fifth shock, administer amiodarone 150mg
How to manage a non-shockable rhythm?
2 minute cycles of cpr followed by rhythm check
Give adrenaline 1mg IV/IO every 3 – 5 minutes
what is the dosing of adrenaline used in ALS
Adrenaline 1mg IV (10ml of 1:10,000)
what is the dosing of amiodarone used in ALS
Amiodarone 300mg IV after 3rd shock
Repeat 150mg IV after 5th shock if ongoing
when should adrenaline be used in ALS
Adrenaline 1mg IV (10ml of 1:10,000)
Shockable rhythm: give after 3rd shock (during CPR). Flush with 20ml saline.
Non-shockable rhythm: give as soon as IV access is established. Flush with 20ml saline.
Repeat adrenaline dose during every other CPR cycle thereafter (i.e. repeat every 3-5 minutes once given, regardless of rhythm)
when should amiodarone be used in ALS
Amiodarone 300mg IV: if shockable rhythm only. Give after 3rd shock (during CPR). Repeat 150mg IV after 5th shock if ongoing.
How should the team leader assess and treat hypoxia
assess: ventilation adequacy, o2 flow rate, abg
treat: 15L/min O2, good ventilation, i-gel
what are the reverisble cuases of cardiac arrest taht should be identified and worked through by the team leader
Hypoxia
Hypovolaemia
Hypokalaemia/hyperkalaemia
Hypothermia/hyperthermia
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins
How should the team leader assess and treat hypovolemia
assess: history, drains, haemorrhage, fluid collections (expose pt)
treat: fluid resuscitation, blood if haemorrhage, stop bleeding
how should the team leader assess and treat hypo/hyperkalaemia
ABG and latest blood results
if hyperkalaemic:
- Protect the heart: calcium chloride
- Shift K into cells: insulin and glucose, sodium bicarbonate
- Remove K from the body: consider dialysis for refractory hyperkalameic cardiac arrest
10 mL calcium chloride 10% IV by rapid bolus injection
10 units soluble insulin and 25 g glucose IV by rapid injection. Monitor blood glucose. Administer 10% glucose infusion guided by blood glucose to avoid hypoglycaemia.
50 mmol sodium bicarbonate (50 mL 8.4% solution) IV by rapid injection.
if hypokalaemic: 20mmol KCl over 10 mins
how should the team leader assess and treat hypo/hyperthermia
assess: pts temp on recent obs, warmth to touch
treat:
hypo = warm pt, extracorporeal CPR
hyper: cool pt, IV fluids
how does the team leader assess and treat tension pneumothorax
assess: tracheal deviation, unilateral hyper-resonance and decreased breath sounds
treat: insert cannula into second intercostal space mid clavicualr line
how should the team leader assess and treat cardiac tamponade
assess: recent chest trauma/surgery/pacemaker insertion/PCI
cardias USS if there is a risk
treat: pericardiocentesis
how should the team leader assess and treat toxins
assess: history, drug chart, capilalry glucose
treat: treat toxaemia eg naloxone for opiods
when is ECMO considered
Extracorporeal CPR using extracorporeal membrane oxygenation (ECMO) device may be considered where available for select patients to facilitate other definitive treatments, e.g. PCI, pulmonary thrombectomy for massive PE, rewarming for hypothermia
for how long should you do CPR? who decides when to stop?
In general, CPR should be continued as long as there is a shockable rhythm (mechanical compression device may be used)
Only stop if a registrar or above makes the decision with the team
defibrilation vs cardioversion
Defibrillation vs cardioversion – defibrillation is a general term often used to describe the shock given to the heart, and more specifically it describes an ‘unsynchronised ‘shock. Cardioversion refers to this shock when it is applied at a specific time in the ECG cycle (a ‘synchronised’ shock).
what are the shockable rhythms
Ventricular fibrillation
Pulseless ventricular tachycardia
what are non-shockable rhythms
PEA – pulseless electrical activity – this means any electrical activity that appears on an ECG like it should be producing a pulse, but it is not. (all electrical activity except VF/VT, including sinus rhythm without a pulse) The most common cause is hypovolaemia.
Asystole – no rhythm present
