Chapter 6: Advanced Life Support Algorithm Flashcards
What are the shockable rhythms?
- VF
- Pulseless VT
What are the non-shockable rhythms?
- Asystole
- PEA
What are the key basic interventions required in all ALS scenarios to improve survival?
- Continuous high quality chest compressions
- Early defibrillation
You notice a patient is unresponsive and not breathing. What are the initial steps in the ALS algorithm?
- Call the resus team
- CPR 30:2
- Attach defibrillator/cardiac monitor
- one below right clavicle, other in V6 position in MAL - Count assistant in to take over chest compressions
- Assess the rhythm
You see a shockable rhythm. What are the next stages of management?
Related to shock energy
- Perform 1 shock (safely) at >150J (typically 200J)
- Immediately resume CPR for a further 2 minutes minimising interruptions
You have shocked a patient once but after 2 minutes, the patient remains in VF. What do you do?
- Safely deliver second shock - typically 300J
- Immediately resume CPR for further 2 minutes
Following 2 shocks, the patient remains in VF. What should you do?
- Shock again at 360J
- Give 1mg IV adrenaline (1:10 000)
- Give 300mg IV amiodarone
- While performing further 2 minutes CPR
How frequently is adrenaline given once it has been started?
- Every 3-5minutes (every alternate cycle)
- Continue for as long as cardiac arrest persist
If organised electrical activity is seen compatible with cardiac output following a shock, what should be done immediately?
3 things to check
Assess for ROSC:
- Check for signs of life
- Check for central pulse
- Assess end-tidal CO2
If there is organised electrical activity but no return of spontaneous circulation, what should be done?
- Continue CPR
- Switch to the non-shockable algorithm
Patient is in PEA
If there is return of spontaneous circulation and electrical activity following treatment for VF, what should be done?
Start post-resus care:
- Use ABCDE approach
- Aim for SpO2 of 94-98%
- Aim for normal pCO2
- 12 lead ECG
- Rx precipitating cause
- Targeted temp Mx
How frequently can amiodarone be given following VF/pVT?
With dosage
- 300mg after 3rd shock
- Further 150mg after 5 shocks
Lidocaine 1mg/kg can be given if no amiodarone available but don’t mix
When should precordial thumps be considered?
- Not recommended routinely
- Use when awaiting arrival of defibrillator
- Very low success rate for cardio version of shockable rhythm
How is a precordial thump given?
- Use ulnar edge of fist
- Strike sternum from height of 20cm
- Immediately retract fist
If a patient has a witnessed and monitored cardiac arrest with VF/pVT, what should be done?
- Give 3 quick successive shocks
- Rapidly check - rhythm change, pulse & signs of life
- If 3rd shock unsuccessful - Start compressions and continue CPR for 2 mins
- Continue normal ALS algorithm as if 1 shock has been given
When is adrenaline and amiodarone given if a patient has stacked shocks due to witnessed VF/pVT?
Adrenaline - assume as if stacked shocks are 1st shock - so after 2 further shocks
Amiodarone - give immediately (during CPR) as it should be given regardless after 3 shocks.
How are non-shockable rhythms managed according to the ALS algorithm?
- CPR 30:2
- Give adrenaline 1mg IV/IO
- Must be continued every 2 cycles regardless of whether it changes to a shockable rhythm
- Check rhythm at 2 minutes and respond as according to this
What classifies as a high quality chest compression?
- Adequate depth - 5/6cm
- Adequate rate - 100-120 bpm
- Ensure full recoil of chest after each compression
- Equal time compression & recoil
- Minimal interruption
- Aim to change individual doing compression every 2 minutes to avoid fatigue