als. objectives prevention of cardiac arrest revision of bls als algorithms - shockable ryhthms -...
TRANSCRIPT
ALS
Objectives
•Prevention of cardiac arrest•Revision of BLS•ALS algorithms - shockable ryhthms - non-shockable rhythms•Potential reversible causes of cardiac arrest•Safe debrillation (Zoll and AED)•Practice ALS scenarios
Early recognition of the critically ill patient
• Most arrests are predictable
• Deterioration prior to 50 - 80% of cardiac arrests
• Hypoxia and hypotension are common antecedents
• Delays in referral to higher levels of care
Call for help early!!!!!
Early recognition prevents:• Cardiac arrests and deaths• Admissions to ICU, inappropriate
resuscitations
• Check for danger• Check for response -
if unresponsive• Call for help/met call
– 666 at Liverpool• Open airway• Check for normal
breathing• Start CPR – 30 chest
compressions, then 2 breaths (30:2)
• Attach AED/defib
Confirm cardiorespiratory arrest
Basic Life Support• Compressions
– lower ½ sternum– >/= 5 cm depth
(1/3 depth chest)– 100 min-1
• Ratio 30:2 breaths until airway secured
• Avoid!– Interruptions (<10
seconds)– Provider fatigue
(swap every cycle)
Airway and ventilation• Oxygenation important NOT intubation• No evidence that intubation improves
outcome (& may interrupt compressions)
• Open airway, place Guedel then Bag-Valve mask ventilation is ok initially
• Met team may consider advanced airway: LMA (or ETT)
• Avoid hyperventilation (6-10/min max)
Rhythm ? – Shockable or Non-Shockable
Ventricular Fibrillation:• Bizarre irregular
waveform• No recognisable QRS
complexes• Random frequency and
amplitude
• Uncoordinated electrical activity
Shockable
Rhythm ? – Shockable or Non-Shockable
Shockable
• VT (monomorphic)– broad complex regular rhythm– rapid rate– constant QRS morphology
Defibrillation• Must be safe – live current!! –all
hands off patient, 02 away• Energy varies with manufacturer -
Check local equipment• Biphasic (Zoll) give 200 J standard
(can alter energy level manually) • AED – automatic – set at 200J• Must do 2 mins CPR after any shock
before checking rhythm
Rhythm ? – Shockable or Non-Shockable
Asystole:• Absent ventricular (QRS) activity• Atrial activity (P waves) may persist• Rarely a straight line trace
Non-shockable
Pulseless electrical activity:• Clinical features of cardiac arrest• ECG normally associated with an output
Non-shockable
CORRECT REVERSIBLE CAUSES
• Hypoxaemia· Hypovolaemia· Hypo/hyperthermia· Hypo/hyperkalaemia & other metabolic disorders· Tamponade· Tension pneumothorax· Toxins / Poisons / Drugs· Thrombus - pulmonary / coronary
Adrenaline Dose: 1mg IV– VF/VT – give after 2nd shock
– Non VF/VT – give immediately
– Repeat every 3-5 min
ie alternate cycles
Any questions
Summary
• ALS algorithm provides a standardised approach to the treatment of cardiac arrest in adults
• Shockable rhythms (VF/pulseless VT)• Non-shockable rhythms• Reversible causes of cardiac arrest• Common drugs used