ALS Flashcards
You have been informed after your AE the patient has stopped breathing your management ?
shake the patient and call him by his name “george can you hear me , can you please open your eyes) =
chin lift head thrust and put your head close to the patient’s mouth - is he making any respiratory effort
At the same time , i’m checking his carotid pulse - can i feel a pulse
CALL FOR HELP SAME TIME
you cannot see the patient is making any respiratory effort and no pulse what is done now ?
Decline the hospital bed
Commence CPR immediately ( in ratio of 30:2 keep the rate 60-100 per min, with 6cm depth)
Can someone call the adult resuscitations team on 2222 and bring the resuscitations trolley
OTHER HELP SHOULD ARRIVE
“
when other help comes what do you do ?
say :
please someone put the bag valve mask , with a 30 :2 ratio , with oxygen up to 15 L , ten breaths per min , see if the chest does get inflated
I’m going to count you in to continue doing cpr”
Apply self adhesive defib / monitoring pads - one below right clavicle and other on v6 position in the mid axillary line
What do you do after the DEFIB PADS are added ?
In a second I’m going to ask you pause CPR for at rhythm check, after that you need to go back on CPR is that clear ?
PAUSE CPR (aim for less than 5sec)
when you check the rhythm it is shockable what do you do ?
“START CPR AGAIN”
VERBALISE IT IS A “SHOCKABLE RHYTHM”
“I’M going to charge the defibrillator (first shock charge ro 120-150j)- im not going to shock yet -TAKE the oxygen away, everybody except the person doing CPR stand clear
head clear , rest of the body clear
“shocking now , Stop CPR and stand CLEAR “
start CPR again with oxygen back in place
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if other people have come in
ASSIGN one person for defibrillation and timing -
assign someone for airway management
assign someone to get the patient notes
“20 second until the next two minutes “
“alright in 20 seconds , we are going to stop chest compression check the rhythm and go straight back into the cpr , I would like YAN to swap with JULE for the CPR at the rhythm check ‘
2 minutes into CPR now
stop CPR please - looking at the monitor that is a shockable rhythm - STRAIGHT BACK ON TO CPR
charging the defibrillator (TO SAME SHOCK ENERGY OR HIGHER) , remove the oxygen , everybody except person doing cpr stand clear - HEAD IS CLEAR BEDSPACE CLEAR
in a second im going ask the PERSON DOING THE CPR to stand clear aswell for shock and go back on cpr after the show
stand clear , shocking now
immediately start CPR again
Second sack delivered an on CPR what next ?
can you please establish an IV line - and give stat 500 ml
some bloods through venepeuncture - UE, FBC , VBG and blood glucose please
person on the defibrillates - tell me when its 20 seconds from the next two minutes again
can we have a definitive airway now please and let me know when it is done please - to check the end tidal C02
I would like some drugs ready please for after the next shock - adrenaline 1mg (10ml 1:10,000 or 1ml in 1:1,000) and amiodarone 300mg
from his history im thinking thromboembolic
4T
and 4H
temperature wise
hypoxia - we got the tube going in - we are going to connect that to 15 L of oxygen
hypovolemia - we are dressing that with giving saline
“20 seconds until next next 2 minutes “
20 seconds until next rhythm check for 3rd shock ?
please charge the defibrillates
everybody stand clear whilst the defibrillates is recharging except the person doing cpr - leave the oxygen connected
head clear , bedspace is clear
in a minute im going to ask the person doing the cpr to stand clear to deliver shock , after the shock is delivered i want them to go straight back into cpr
CPR person stand clear
shock delivered
back to cpr
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what is the end tidal volume c02
please can we give 1mg adrenaline
followed by 300 mg amiodarone please
let me know when that’s done
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2 min sequence of rhythm check and shock
with further 1mg adrenaline IV after alternate shock or ever 3-5 min
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if there are no signs of ROSC - continue cpr and switch to non shockable rhythm
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thinking of pneumothorax - check if trachea is central and listen ot he chest if you can hear air entry on both side ?- if yes not a pneumothorax
blood gas results - is potassium and glucose all within normal range
cardiac tamponade - can we please order focused cardiac ultrasound
if rosc
full a-e
chest x ray
12 lead ecg
contact the family
need to speak to intensive care team
