ALS

Question 1

order according to uk resus guidelines

Answer 1

Question 2

Witnessed, monitored VF/pVT

Answer 2

• If a patient has a monitored and witnessed cardiac arrest in the catheter laboratory, coronary care unit, a critical care area or whilst monitored after cardiac surgery, and a manual defibrillator is rapidly available:
• Confirm cardiac arrest and shout for help.
• If the initial rhythm is VF/pVT, give up to three quick successive (stacked) shocks.
• Rapidly check for a rhythm change and, if appropriate, ROSC after each defibrillation attempt.
• Start chest compressions and continue CPR for 2 min if the third shock is unsuccessful.
• This three-shock strategy may also be considered for an initial, witnessed VF/pVT cardiac arrest if the patient is already connected to a manual defibrillator – these circumstances are rare. Although there are no data supporting a three-shock strategy in any of these circumstances, it is unlikely that chest compressions will improve the already very high chance of ROSC when defibrillation occurs early in the electrical phase, immediately after onset of VF/pVT.
• • If this initial three-shock strategy is unsuccessful for a monitored VF/pVT cardiac arrest, the ALS algorithm should be followed and these three-shocks treated as if only the first single shock has been given.

Question 3

Treatment of PEA and asystole

Answer 3

Treatment of PEA and asystole

1. Start CPR 30:2
2. Give adrenaline 1 mg IV as soon as intravascular access is achieved
3. Continue CPR 30:2 until the airway is secured – then continue chest compressions without pausing during ventilation
4. Recheck the rhythm after 2 min:

a. If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life

i. If a pulse and/or signs of life are present, start post resuscitation care
ii. If no pulse and/or no signs of life are present (PEA OR asystole):

1. Continue CPR
2. Recheck the rhythm after 2 min and proceed accordingly
3. Give further adrenaline 1 mg IV every 3–5 min (during alternate 2-min loops of CPR)

b. If VF/pVT at rhythm check, change to shockable side of algorithm.

Whenever a diagnosis of asystole is made, check the ECG carefully for the presence of P waves because the patient may respond to cardiac pacing when there is ventricular standstill with continuing P waves. There is no value in attempting to pace true asystole.