Advanced Life Support Algorithm Flashcards
ALS Agorithm - Initial Assessment?
Unresponsive and not breathing normally
Call Resus Team
Start CPR 30:2 (uninterrupted chest compressions if alone whilst pads attached)
Attach defibrillation pads/monitor
Assess rhythm (pause for less than 5 seconds)
Resume chest compressions
ALS Algorithm - Shockable Rhythm (pVT/VF)?
Resume chest compressions
Warn other members to stand clear and remove any oxygen delivery devices
Defibrillation member - energy 120J-150J for first shock, same or higher for sunsequent
Charge defib
Tell chest compression member to stand clear, when clear, give shock
After shock - immediately restart CPR 30:2, starting with chest compressions
Continue for 2 minutes, then team leader preps for brief pause in CPR to check monitor
If VF/pVT persists - deliver shock again etc
If electrical activity compatible with life - chest signs of life
- If ROSC - post resuscitation care
- If no signs of ROSC despite PEA or asystole - switch to non shockable algorithm
ALS Algorithm - Shockable Rhythm - Drugs?
After 3rd shock:
IV Adrenaline 1mg
IV Amiodraone 300mg
Every alternate shock following:
IV Adrenaline 1mg (3-5 minutes)
When can you give further doses of adrenaline and amiodarone in shockable rhythms?
Adrenaline every 3-5 mins alternate shocks
Amiodarone further 150mg after 5 shocks
Can give lidocaine 1mg/kg if amiodarone not already given
Management of monitored VF/pVT cardiac arrest
Confirm cardiac arrest, shout for help
If initial rhythm VF/pVT - 3 quick successive (stacked) shocks
Check for rhythm and pulse after each attempt
Start chest compressions and continue CPR if shocks unsuccessful
When to give drugs in monitored VF/pVT cardiac arrest
Adrenaline - First 3 shocks considered 1st shock of ALS so give adrenaline after further 2 shocks
Amiodarone - after initial three shock attempts stacked
Management of PEA/Asystole ALS?
Start CPR
IV Adrenaline 1mg as soon as IV access achieved
Continue CPR 30:2 until airway secured, then continuous chest compressions
Recheck rhythm each 2 minutes
Further adrenaline every 3-5 minutes
Chest compressions depth and rate?
5-6cm
100-120/min
Ensure full recoil of the chest at end of each compression
Airway - what should be used?
Bag-mask or iGel airway
Until tracheal intubation can be done by skilled technician
Avoid stopping chest compressions during laryngoscopy and intubation, if necessary <5 seconds
Monitoring in CPR (7)?
Clinical Signs - breathing efforts, movement, eye opening
Pulse Checks
Heart Rhythm
End-Tidal CO2 during waveform capnography
Feedback/Prompt Device
Blood sampling and analysis (VBG/ABG)
Invasive CV monitoring in CCU
Focused Echo/USS
Waveform Capnography - roles? (5)
Ensure tracheal tube placement in trachea
Monitoring ventilation rate during CPR
Monitoring quality of chest compressions
Identifying ROSC (increase in end tidal CO2 may indicate ROSC)
Prognostication - low values correlate with low ROSC rates and increased mortality
Normal end tidal CO2?
4.8kPa
(4.3-5.5kPa)
What to do if signs of ROSC, movement, BP waveform, rise in ET CO2?
Consider brief pause in chest compressions for rhythm analysis
Pulse check if appropriate
If pulse palpable - post ROSC care and treatment of peri-arrest arrhythmias
How much flush to give when drugs given peripherally in ALS?
At least 20mls of fluid and elevation of extremity for 10-20 seconds
What are the 4H’s and 4T’s?
Hypoxia
Hypothermia
Hypovolaemia
Hyperkalaemia/hypokalaemia/hypoglycaemia/hypocalcaemia and other metabolic disorders
Toxins
Thrombosis (coronary and pulmonary)
Tamponade
Tension pneumothorax
