ALS algorithm

Question 1

first steps on starting the situation - the common stem

Answer 1

1 - assess. unresponsive/not breathing/ hardly breathing?
2 - call the resus team on 2222
3 - do CPR 30:2 - BLS ALGORITHM
4 - attach the defibrillator or ECG monitor and ASSESS THE RHYTHM

Question 2

on assessing heart rhythm what are the choices in the algorithm?

Answer 2

left hand loop for shockable rhythms = VF and pulseless VT

right hand loop for non shockable rhythms = PEA or asystole

or spontaneous circulation may return thanks to the BLS CPR.

Question 3

if the PT is in a shockable rhythm, what happens?

Answer 3

shockable = VF and pulseless VT.

remember - VT WITH a pulse can rapidly degenerate into pulseless VT.

once rhythm is assessed
1 - ONE shock
2 - immediately resume CPR for 2 minutes
3 - reassess rhythm

whilst in the left hand loop, need to have someone else doing ABCD

A = get a definitive airway. an endotracheal tube or a laryngeal mask airway. once this is in place do continuous compressions as the breathing is now done by the airway.

B = get oxygen in the PT. on a ventilator even. an ABG

C = 2 widebore cannulae in the antecubital fossae. take bloods; U and Es, FBC, clotting, group and save. can use interosseous access in really necessary.

D = drugs. ADRENALINE, 1mg, every 3-5 minutes after the 3RD shock. causes peripheral vasocon to shunt blood centrally. AMIODARONE 300mg ONCE ONLY.

E = correct reversible causes

Question 4

name 8 reversible causes

Answer 4

4 Hs, 4Ts.

hypoxia, hypovolaemia, hypothermia, hypo/hyperkalaemia

thrombosis, tamponade, toxins, tension pneumothorax.

Question 5

if the PT is in a NON-shockable rhythm, what happens?

Answer 5

non shockable = Pulseless electrical activity or asystole

right hand loop

once rhythm is assessed
1 - immediately resume CPR for 2 minutes.
2 - assess rhythm

whilst in the right hand loop, need to have someone else doing ABCD

A = get a definitive airway. an endotracheal tube or a laryngeal mask airway. once this is in place do continuous compressions as the breathing is now done by the airway.

B = get oxygen in the PT. on a ventilator even. an ABG

C = 2 widebore cannulae in the antecubital fossae. take bloods; U and Es, FBC, clotting, group and save. can use interosseous access in really necessary.

D = drugs. ADRENALINE, 1mg, STAT (unlike with left hand loop). causes peripheral vasocon to shunt blood centrally. no amiodarone unlike left hand loop.

E = correct reversible causes

Question 6

what happens if you assess the rhythm and spontaneous circulation has returned

Answer 6

1 - ABCDE assessment.
2 - oxygenate and ventilate
3 - 12lead ECG
4 - treat precipitating cause
5 - temperature control/therapeutic hypothermia