Transcript Advanced Cardiac Resusitation Guidelines

Advanced Cardiac Resuscitation
Guidelines
By
Muhammad Bayat
BLS- HAZARDS
• Hazards- Make sure
the scene is safe for
you to help.
Make sure you have
universal precautions:
gloves, Face Mask,
and Apron
BLS- HELLO + HELP
• Determine if the
patient is conscious by
tapping and shouting
"Are you OK?"
If no response have
someone call for the
crash cart
BLS- Airway
• Position the patient on
their back.
Open the airway with
a head-tilt chin-lift or
jaw-thrust maneuver.
• Suction the airway and
clear out any foreign
bodies
• Insert an appropriate
sized Guedel airway
BLS - Breathing
• LOOK-LISTEN-&FEELING for breaths
• CHECK REATHING
FOR 5-10 SECONDS.
• If they isn’t breathing
VENTILATE TWICE
-Rescue Breathing
BLS- Circulation Check
• Check for a pulse by
palpating(feeling) the
carotid artery. CHECK
THE PULSE FOR 10
SECONDS.
BLS- Circulation
• If there is no pulse
BEGIN CHEST
COMPRESSIONS at a
rate of 15
COMPRESSIONS to
2 BREATHS for both
one and two man CPR
BLS - CPR
• Recheck the pulse
after ONE MINUTE.
CONTINUE UNTIL
HELP ARRIVES, OR
UNTIL YOU FEEL
TOO TIRED TO
CONTINUE.
Approximately 4
cycles will pass before
the pulse check
Advanced Life Support
• Recommended Minimum Equipment for the
Management of Adult Cardiopulmonary
Arrest
AIRWAY EQUIPMENT
• Self inflating resuscitation bag with oxygen
reservoir and tubing -BVM
• Laryngoscopes x 2 - normal and long blades
• Spare laryngoscope bulbs and batteries
ALS AIRWAY EQUIPMENT
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1" ribbon gauze/tape
Scissors
Syringe - 20 mls
Oxygen cylinders x 2 (if no wall oxygen)
KY Jelly
ALS - Equipment
CIRCULATION EQUIPMENT
• Intravenous cannulae 18 gauge x 3, 14
gauge x 3
• Hypodermic needles 21 gauge x 10
• Syringes 2 mls x 6, 5 mls x 6, 10 mls x 6,
20 mls x 6
• Intravenous giving sets
• IV Infusion Fluid- MRL
Basic ALS Drugs
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DRUGS
Adrenaline / Epinephrine 1 mg (1:1000)
Atropine 3 mgs
Amiodarone 300mgs
Phenergan
Hydrocortisone
Lignocaine
ALS - Additional Equipment
ADDITIONAL ITEMS
• ECG Electrodes
• Defibrillation Gel pads
• Pulse Oximeter
• Gloves/Goggles/Aprons
• NIBP Monitor
ALS- Management
Heart rhythms associated with cardiac arrest
can be divided into two groups:
1.) ventricular fibrillation / pulseless
ventricular tachycardia (VF/VT)
2.)Other rhythms. Asystole and pulseless
electrical activity (PEA).
ALS -Rhythm
Why the Differentiation?
• The management of these two groups of
arrhythmias is different
• Defibrillation in those patients with VF/VT
• Drugs used in the other rhythms
ALS- Rhythm Recognition
Similarities
• CPR , Airway management and Ventilation,
venous access, the administration of
epinephrine (adrenaline) and the
identification and correction of contributing
factors, are common to both groups.
ECG RHYTHMN
REGONITION
• Ventricular Fibrillation • Asystole
ALS- Defibrillation
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Turn on the Machine
Change Lead Select
Gel the Paddles
Confirm the Rhythm
Set Energy level at
200J
3 stacked defibrillation
of 200,200,360J
ALS- Advanced Airway
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Prepare Equipment
Insert Airway
Check Position
Ventilate
Consider Surgical
Airway Cricothyroidotomy
ALS- Drug Therapy
VENTRICULAR FIBRILLATION
Adrenaline
• Dilute 1mg of 1:1000 adrenaline into 10mls
• Give 1mg every 3minutes followed by a
stacked shock after 1 minute of CPR
• Maximum dose = 3mg
ALS- Drug Therapy
Atropine
• Used in Asystole and PEA
• Mech.. Of Action : Vagolytic Drug
• Given at a dose of 1mg every 3 minutes till
a maximum of 3mg
ALS- Drug Therapy
Amiodarione
• Used in persistent VF that remains despite
adrenaline
• Used post 2nd defibrillation attempt
• 300mgf bolus given mixed with 20ml of
dextrose
Anaphylaxis
Clinical Features
• Urticaria (hives)
and/or angioedema
• Hypotension -Shock
• Upper Resp Tract
Obstruction.
• Bronchospasm
• Cyanosis
Anaphylaxis-Treatment
• Prevention
• ALS- Airway Protection,Breathing,
Circulation
• Adrenaline (0.5ml IMI & Nebulised & IV)
• Antihistamines (Promethazine 25mg)
• Adrenergic Agonists (Salbutamol Nebs)
• Hydrocortisone (200mg IVI)
ALS- Take Home Message
• Do Not Panic
• Remember ABC’s
• Defibrillate only a VF/VT & remember the
GEL
• Adrenaline is common drug to all the
protocols