BLS and ALS Approach

Question 1

Initial approach

Answer 1

Check patient surroundings for safety
PPE up

Response - shake and shout ‘are you alright’
No response => Get help, BLS/ALS depending on setting
Response => A-E assessment

Question 2

No response from patient

Answer 2

GET HELP

Do they have any potential neck injuries? => restrict neck
-jaw thrust
If not => head tilt chin lift

Check for airway obstructions
-remove safely
Carotid pulse check, assess for breathing
-chest mv, breath sounds, air blowing against cheek

Question 3

Signs of life

Answer 3

Pulse present, RR low (U12) => bag valve mask with high flow O2, recheck pulse
-needs someone else to hold mask over mouth

Pulse present, RR normal => A-E assessment

Agonal breathing or not breathing => cardiac arrest

• Call ambulance, ask someone to get you a defib
• CRASH CALL 2222, location, adult/child

Question 4

Chest compressions and ventilation

Answer 4

30compressions-2ventilations 120BPM

• Lower half of sternum, compress 1/3
• Allow for full recoil

Ventilation

• head tilt chin lift
• close nostrils
• BVM, pocket mask
• watch for chest rising
• add 15L O2 if possible
• if needed, use airway adjuncts

If ventilation without equipment is not available yet, cont chest compressions until equipment arrives

If airway secure with SMA or intubated => continuous CPR

Question 5

Defibrillation

Answer 5

Can continue chest compressions whilst pads are placed

Rhythm check every 2 mins - stop compressions, feel carotid pulse
-if rhythm and pulse compatible with life felt => stop CPR

Shockable - pulseless VT/VF

• ask O2 to be removed but cont CC
• charge DF
• ask everyone to step away from the patient => shock
• immediately restart 2mins CPR

Non shockable/PEA => cont 2mins CPR

Question 6

Drugs used in ALS

-how and when to use them

Answer 6

IV 2 large bore cannula/IO access via tibial tuberosity, humeral head

• VBG, FBC, U&E, G&S, Mg
• IV fluids

Adrenaline 1mg IV - peripheral VC to maximise cardiac blood flow
-shockable - after 3rd shock
-non shockable - STAT IV
REPEAT EVERY OTHER SHOCK

Amiodarone 300mg IV - stabilise heart in VT/VF
-shockable - after 3rd shock

Question 7

How to manage the patient after ROSC

Answer 7

Out of hospital => transfer to clinical environment

A-E

• controlled O2 (94-98%)
• therapeutic hypothermia (32-36) for 1 day
• post arrest imvestigations (CXR, 12ECG, bloods, echo, ABG, BM, cardiac monitoring)
• treat cause
• transfer to ICU if ventilation needed
• otherwise => HDU

Question 8

Reversible causes of cardiac arrest

• what are the 4Hs, 4Ts
• how to assess
• how to treat

Answer 8

Hypoxia => 15L O2, good seal
-adequate ventilation, O2 flow, ABG

Hypovolemia => fluid resus
-Hx, drains, bleeds, fluid collections

Hypo/Hyperkalemia => [CaCl, insulin dextrose][KCl infusion]
-ABG

Hypothermia - warm patient
-temp, observations

Thrombosis (heart/lung) => thrombolysis/cardiology
-Hx, risk factors, DVT, Wells score

TP => needle decompression, 5ICS MAL
-tracheal deviation + hyperresonance

Tamponade => pericardiacocentesis
-chest trauma, FAST

Toxins => treat underlying cause
-Hx, drug chart, BM

Question 9

No return of circulation

Answer 9

CPR continues until there is a shockable rhythm

Stop if senior makes decision with team