basic life support for healthcare providers · basic life support for healthcare providers basic...

BASIC LIFE SUPPORT FOR HEALTHCARE PROVIDERSBASIC LIFE SUPPORT FORHEALTHCARE PROVIDERS

2015 2015

Immediately resume CPR starting with compressions.

Continue for 2 minutes



Start Compressions

Compress the chest fast (almost 2 per second)Push hard / Ensure full chest recoil /

Minimize interruptions

Breaths

If unable to perform breaths, do continuous compressions until equipment arrives

Give 1 Shock

Monophasic – 360JBiphasic – 120 - 360J

Paediatric – 4J/kg

Attach AED / Defib immediately

Shock Advised(VF/VT)

No Shock Advised(PEA/Asystole)

• No Pulse or not sure• Pulse rate <60 in children and infants

• Give rescue breaths

• Adult: every 6 seconds• Child: every 5 seconds• Infant: every 4 seconds

• Reassess continuously

Has pulse but no effective breathing

• Place in recovery position • Check for continued breathing• Reassess continuously

Has pulse and breathing

Continue until AED / Defib arrives

ANALYSE RHYTHM

www.resuscitationcouncil.co.za

CPR FOR EVERYONECPR FOR EVERYONE

2015 2015

Not awake and not breathing normally?

• Push on the middle of the chest 30 times• Give 2 breaths

Awake or breathing normally?

• Roll patient on their side.• Keep checking for breathing until help arrives.

AED• Use AED when it arrives

Local Ambulance:....................112

10177

Ensure safety

Tap and shout: 'Are you okay?'

Is the person:

Awake?

Breathing?

Call for help?

How to use an AED

• Switch "on”• Follow the voice prompts• Attach pads to bare chest• Attach end of cable to AED• Stand clear and allow analysis• Press shock button if prompted• Immediate CPR after shock delivered, starting with chest compressions

If unable to give breaths, push on the chest repeatedly

KEEP DOING CPRUNTIL HELP ARRIVES


ADVANCED CARDIAC ARREST ALGORITHM

Adult and Paediatric

ADVANCED CARDIAC ARREST ALGORITHM

Adult and Paediatric2015 2015

Start Compressions

Compress the chest fast (almost 2 per second)

Push hard / Ensure full chest recoil /

Minimize interruptions

Attempt 2 breaths at 1 breath/second(with if available) after every 30 compressions

Continue until AED / Defib arrives

BreathsIf unable to perform breaths, do continuous compressions until equipment arrives

Attach AED / Defib immediately

• No Pulse or not sure• Pulse rate <60 in

children and infants

• Give rescue breaths

• Adult: every 6 seconds• Child: every 5 seconds• Infant: every 4 seconds

• Reassess continuously

Has pulse but no effective breathing

• Place in recovery position • Check for continued breathing• Reassess continuously

Has pulse and breathing

Contributory Causes:• Hypoxia• Hypovolaemia• Hypothermia• Hydrogen ion (Acidosis)• Hypo- / Hyperkalaemia• Hypoglycaemia• Tension Pneumothorax• Tamponade (Cardiac)• Toxins• Trauma• Thrombosis (Coronary)• Thrombosis (Pulmonary)

High Quality CPR:• Compression rate 100 – 120 per minute• Avoid excessive ventilation; 1 breath every 6 seconds if advanced airway • Rotate compressors every 2 minutes• Consider capnography and arterial monitoring

Advanced Considerations:Correct contributory causes• Obtain IV/IO access, take ABG/VBG• Give high levels of Fi and consider •

advanced airway if requiredContinuous chest compressions •

after advanced airway in placeConsider Adrenaline and •

antiarrhythmics:Adrenaline 1mg every 3 - 5 min •

(0.01mg/kg in paed)Amiodarone 300mg followed by •

150mg (5mg/kg in paed) or if not available Lignocaine 1.5mg/kg initial,

followed by 0.5mg/kg (max 3mg/kg)



Give 1 Shock

Monophasic – 360JBiphasic – 120-360J

Paediatric – 4J/kg

Shock Advised(VF/VT)



No Shock Advised(PEA/Asystole)

ANALYSE RHYTHM

Additional considerations:1) VA ECMO might be considered in appropriate centres when available;

2) Ultrasound can be considered as a diagnostic and procedural tool where training and resources exist.


BRADYCARDIA MANAGEMENT ALGORITHM

BRADYCARDIA MANAGEMENT ALGORITHM

2015 2015

Alternatives• Transvenous pacing

• High dose Insulin (1 U/kg if BB or CCB)• Glucagon (if BB or CCB overdose)

ADRENALINE(0.05μg/kg/min 0.5 μg/kg/min

infusion)OR

TRANSCUTANEOUS PACING

ATROPINE(Exclude Hypoxia/Hypothermia/

Head injury)

0.5 mg IV bolusCan repeat every 3 - 5 minutes,

up to 3 mg

BRADYCARDIAHR < 60/min despite effectiveoxygenation and ventilation

IF UNSTABLE

START CPR1 Rescuer = 30 compressions : 2 breaths2 Rescuers = 15 compressions : 2 breaths

ADRENALINE0.1 ml/kg IV of 1:10 000 dilution(Max - 1 mg) every 3 - 5 minutes

ATROPINE0.02 mg/kg IV if vagal tone or

1° AV blockMaximum 0.5mg

CONSIDER PACING

BRADYCARDIAHR < 50/min

IF UNSTABLE

SIGNS OF INSTABILITY• Hypotension

• Acutely altered mental state• Signs of shock

• Ischaemic chest discomfort• Acute heart failure

ECG RHYTHMRun rhythm strip to confirm dysrhythmia

12 lead ECG if possibleIdentify and treat underlying causes

DRIPEstablish IV access

CIRCULATIONAssess pulse, blood pressure and

perfusionAttach ECG monitor, pulse oximeter and vital signs monitor if available

BREATHINGAdminister oxygen if required. Target Saturation 94-98%

Ventilate if necessary

AIRWAYOpen, maintain and protect as necessary

* BB = Beta Blockers* CCB = Calcium Channel Blockers

SPECIALIST MEDICAL ADVICE SHOULD BE SOUGHT

WHENEVER POSSIBLE

ADULT PAEDIATRIC

Look for and treat contributory causes

of Bradycardia

• Hypoxia• Hypothermia• Head Injury

• Hyperkalaemia• Heart Block

• Hydrogen Ion (Acidosis)• Hypotension

• Toxins(e.g. organophosphates)

• Theraputic Agents (e.g. beta blocker overdose/

calcium channel blocker overdose)


TACHYCARDIA MANAGEMENT ALGORITHM

TACHYCARDIA MANAGEMENT ALGORITHM

2015 2015

AMIODARONE150 mg in 5% D/W over 10 minutes

IV (15 mg/min) then 1 mg/min infusion

Alternatives (esp irregular rhythms)

• BB or CCB

ADENOSINE (NOT if varying R-R intervals /

Atrial fibrillation)6 mg IV rapidly, then 12mg IV

after 1 - 2min prn

AlternativesIce water applied to face

Coughing / Breath-holdingCarotid Sinus Massage (C/I if bruits,

CVS disease, elderly)

VAGAL STIMULATION(NOT if varying R-R intervals /

Atrial fibrillation)Preferable: Valsalva (Modified)

NARROW COMPLEX TACHYCARDIA

(Supraventricular Tachycardia)HR > 150/min with QRS < 0.12 sec

Alternatives (esp irregular rhythms)

• BB or CCB

Consider (if Torsades de Pointes):• Defibrillation (Asynchronous)

• Magnesium (2g IV over 10min)• Correct Electrolytes and consider

toxins/drugs

AMIODARONE150 mg in 5% D/W over 10min IV (15 mg / min), then 1 mg / min infusion

WIDE COMPLEXTACHYCARDIA

(Ventricular Tachycardia)Generally HR > 150/min with

QRS > 0.12 sec

ECG RHYTHMRun rhythm strip to confirm dysrhythmia

12 lead ECG if possibleIdentify and treat underlying causes

SIGNS OF INSTABILITY• Hypotension

• Acutely altered mental state• Signs of shock

• Ischaemic chest discomfort• Acute heart failure

TACHYCARDIAHR > 150/min * See Paed Rates

SYNCHRONISED CARDIOVERSION

Consider procedural sedation

Start with 100J initially(monophasic or biphasic)

UNSTABLE

DRIPEstablish IV access

CIRCULATIONAssess pulse, blood pressure and

perfusionAttach ECG monitor, pulse oximeter and vital signs monitor if available

BREATHINGAdminister oxygen if required. Target Saturation 94 - 98%

Ventilate if necessary

AIRWAYOpen, maintain and protect as necessary

STABLE

Paediatric start 0.5 - 1J/kgthen 2J/kg (Max 4J/kg)

Paediatric Drug DosesAdenosine 0.1mg / kg rapidly

followed by 0.2mg / kg

Amiodarone 5mg / kgover 20 - 60min (max 300mg)

Magnesium 50 mg / kg

SPECIALIST MEDICAL ADVICE SHOULD BE SOUGHT

WHENEVER POSSIBLE

* BB = Beta Blockers* CCB = Calcium Channel Blockers

* Paediatric Tachycardia Rates

QRS < 0.08sec

QRS > 0.08 sec


NEWBORN RESUSCITATION ALGORITHM


2015 2015




2015 2015


Continue compressions and ventilation Give 0.1 - 0.3 ml/kg Adrenaline IV (1:10 000 dilution)

(1 ml/kg Adrenaline ETT (1:10 000 dilution) only if no IV access)May repeat Adrenaline IV after 3 – 5 min

Correct hypovolaemia if necessary (10 ml/kg NS IV over 5 - 10 min)

Consider pneumothorax / Check glucose

HR <60

Assess breathing, heart rateand sats /colour

Continue ventilating with supplemental oxygen as required Consider intubation

Start chest compressions with coordinated ventilation(3 compressions : 1 breath)

Each cycle should take 2 seconds

HR <60


every 30-60 seconds

HR <100


every 30 - 60 seconds

Start ventilating with room air (Rate: 30 - 40/min)Use oxygen if preterm starting at 30 - 40%

Connect to pulse oximeter if available, avoid hyperoxia Ensure chest rise with each breath

Ventilate with supplemental oxygen as required

Provide warmthClear airway if necessary

Dry and stimulate (Don't dry if <30 weeks - Wrap preterm baby's torso in plastic bag)

Note the time

Assess breathing/crying and/or heart rate

Gasping, apnoeic or HR <100

MA

INTA

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MIA

If ongoing Respiratory Distress – consider CPAP

BIRTH

GO

LD

EN

MIN

UT

E -

60 s

eco

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s

Cry/breathe well & good tone

Term gestation?Breathing?

Good Tone?

Oxygen AdministrationUse blended if available

to achieve targeted pre-ductal sats (see below)

Alternatively:• Bag with no ≈ 21%

• Bag with ≈ 40%• Bag with + Reservoir ≈ 100%

Normal pre-ductal sats after birth

(right hand or ear)

1 min: > 60%2 min: > 65%3 min: > 70%4 min: > 75%5 min: > 80%

> 10 min: 90 - 95%

Post Resuscitation Care

• Maintain normothermia36.5° - 37.5°C

• Consider InducedHypothermia where available

according to protocol

• If ongoing respiratory distress – consider nasalCPAP and surfactant as

required according to protocol

• Maintain sats 90 - 95%

If chest NOT moving:

- Mask seal adequate?- Obstruction?(Secretions/Positional)- Ventilate more firmly?- Intubate if needed?- Nasal choanal atresia?- Gastric distension?

MO

VING

POST CARDIAC ARREST CARE(Return of Spontaneous Circulation)

Circulatory ControlMaintain and monitor perfusion

• Initially target SBP > 90 mmHg (MAP > 65 mmHg)• Urine output

• Lactate levels

Advanced monitoring• Monitor HR, BP, capillary refill

• Consider appropriate fluid administration• Consider inotrope infusion

Breathing Support• If required ventilate every 6 seconds

• Target normoxia; oxygen saturation at 94 - 98%• Target normocarbia (C 35 – 45 mmHg)

• Apply protective lung ventilation when appropriate

Airway Management• Open and maintain• Intubate if required

• Use capnography when available

Suggested Initial Ventilation• Tidal Vol of 6 ml/kg (ideal weight) • PEEP of ≥ 5 cmH • Target pH of > 7.20)

Inotrope AdministrationStart Adrenaline at 0.05μg/kg/min and titrate to effect

Differential DiagnosisSearch for contributory causes

Hypoxia • Hypovolaemia •

Hypo/hyperkalaemia • Hydrogen ion imbalance (Acidosis) •

Hypoglycaemia •Hypothermia •

• Tension pneumothorax• Tamponade• Thrombosis (coronary)• Thrombosis (pulmonary)• Toxins and drugs• Trauma

Evaluation• 12 lead ECG (including right-sided ECG)

• Coronary angiography if arrest of suspected cardiac origin• Early Reperfusion if indicated (especially STEMI or LBBB)

• Continuous ECG monitoring• Haemodynamic monitoring

• Appropriate Laboratory investigations

'Freezing' (Targeted Temperature Management) Using established cooling strategies and existing protocols

• Maintain a constant targeted T° between 32 - 36°C for > 24 hours• Monitor glucose, electrolytes (especially K, Ca, Mg, Po�),

and Haemodynamic status• Rewarm at 0.25°C per hour

• Avoid rebound hyperthermia (T° > 37.5°C)

Glucose Control• Maintain blood glucose at

8 - 10 mmol/l • Avoid hypoglycaemia

Head / Neuro Evaluation• Treat seizures aggressively• Consider EEG monitoring• Consider brain imaging

• Delay prognostication for at least 72 hours post normothermia

UNRESPONSIVE

RESPONSIVE

A

B

C

D

E

F G

H

POST CARDIAC ARREST CARE(Return of Spontaneous Circulation)

2015 2015


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