erc summary 24 pages

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Summaryof the main

changes in theResuscitationGuidelines

EUROPEAN

RESUSCITATION

COUNCIL

ERC GUIDELINES 2010

2

Published by:European Resuscitation Council Secretariat vzw,Drie Eikenstraat 661 - BE 2650 Edegem - BelgiumWebsite: www.erc.eduEmail: [email protected]: +32 3 826 93 21

European Resuscitation Council 2010.

All rights reserved. We encourage you to send this document toother persons as a whole in order to disseminate the ERC Guidelines.No part o this publication may be reproduced, stored in a retrievalsystem, or transmitted in any orm or by any means, electronic,mechanical, photocopying, recording or otherwise or commercialpurposes, without the prior written permission o the ERC.Version1.2

Disclaimer: No responsibility is assumed by the authors and thepublisher or any injury and/or damage to persons or property as

a matter o products liability, negligence or otherwise, or rom anyuse or operation o any methods, products, instructions or ideascontained in the material herein.

E u r o p e a nR e s u s c i t a t i o n

C o u n c i lTo p r e s e r v e h u m a n l i e b y m a k i n g

high quality resuscitation available to allThe Network o National Resuscitation Councils


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Basic lie support

Changes in basic lie support (BLS) sincethe 2005 guidelines include:

Dispatchers should be trained to

interrogate callers with strict protocols

to elicit inormation. This inormation

should ocus on the recognition o

unresponsiveness and the quality o

breathing. In combination with unre-sponsiveness, absence o breathing or

any abnormality o breathing should

start a dispatch protocol or suspect-

ed cardiac arrest. The importance o

gasping as sign o cardiac arrest is

emphasised.

All rescuers, trained or not, should

provide chest compressions to victims

o cardiac arrest. A strong empha-

sis on delivering high quality chest

compressions remains essential. The

aim should be to push to a depth o

at least 5 cm at a rate o at least 100

compressions min-1, to allow ull chest

recoil, and to minimise interruptions

in chest compressions. Trained rescu-

ers should also provide ventilationswith a compressionventilation (CV)

ratio o 30:2. Telephone-guided chest

compression-only CPR is encouraged

or untrained rescuers.

The use o prompt/eedback devic-

es during CPR will enable immediate

eedback to rescuers and is encour-aged. The data stored in rescue equip-

ment can be used to monitor and

improve the quality o CPR perorm-

ance and provide eedback to pro-essional rescuers during debriefng

sessions.

Electrical therapies:automated external def-brillators, defbrillation,cardioversion and pacing

The most important changes in the 2010ERC Guidelines or electrical therapiesinclude:

The importance o early, uninter-

rupted chest compressions is empha-

sised throughout these guidelines.

Much greater emphasis on mini-

mising the duration o the pre-shock

and post-shock pauses; the continua-

tion o compressions during charging

o the defbrillator is recommended.

Immediate resumption o chest

compressions ollowing defbrillationis also emphasised; in combination

with continuation o compressions

during defbrillator charging, the

delivery o defbrillation should be

achievable with an interruption in

chest compressions o no more than 5

seconds.

Saety o the rescuer remains par-

amount, but there is recognition in

Summary o main changes since 2005 Guidelines

4

Adult Basic Lie Support

Shout or help

Open airway

NOT BREATHING NORMALLY?

Call 112*

2 rescue breaths30 compressions

30 chest compressions

UNRESPONSIVE?

*or national emergency number


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5

Unresponsive?

Call or help

Send or go or AEDCall 112*

Open airway

Not breathing normally

CPR 30:2Until AED is attached

Shockadvised

No shockadvised

1 Shock

Immediately resume:

CPR 30:2

or 2 min

Immediately resume:

CPR 30:2

or 2 min

Continue until the victim starts

to wake up: to move, openseyes and to breathe normally

AED

assesses

rhythm

* or national emergency number

Automated External Defbrillation

6

Collapsed/sickpatient

ShoutorHELP&assesspatient

AssessABCDE

Recognise&treat

Oxygen,monitoring,ivaccess

Callresuscitationteam

Iappropriate

Han

dovertoresuscitationteam

Callresuscitationteam

CPR30:2

withoxygenandairwayadjuncts

Applypads/monitor

Attemptdefbrillationiappropriate

AdvancedLieSupport

whenresuscitationteamarrives

InHospitalR

esuscitation

No

Yes

Signso

lie?


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9

AssessusingtheABCDEapproach

EnsureoxygengivenandobtainIVaccess

MonitorECG,B

P,SpO2,record12leadECG

Identiyandtreatreversiblecauses(e.g.e

lectrolyteabnormalities)

NarrowQRS

Isrhythmr

egular?

Usevagalmanoeuvres

Adenosine6mgrapidIVb

olus;

iunsuccessulgive12mg

;

iunsuccessulgiveurthe

r12mg.

MonitorECGcontinuously

Normalsinusrhythmr

estored?

Possibleatrialutter

Controlrate(e.g.

-Bloc

ker)

Probablere-entryPSVT:

Record12-leadECGinsinus

rhythm

Irecurs,g

iveadenosineaga

in&

considerchoiceoanti-arrh

ythmic

prophylaxis

IrregularNarrowComple

x

Tachycardia

Probableatrialfbrillation

Controlratewith:

-Blockerordiltiazem

Considerdigoxinoram

iodaronei

evidenceoheartailure

Anticoagulateiduration

>48h

Assessorevidenceo

adversesigns

1.

Shock

2.Syncope

3.

Myocardialischaemia

4.Heartailure

Synchronise

dDCShock*

Upto3

attempts

Tachycardia(withpulse)

Amiodarone300m

gIVover

10-20minandrepeatshock;

ollowedby:

Amiodarone900m

gover24h

BroadQRS

Is

QRSregular?

Possibilitiesinclude:

AFwithbundlebranchblock

treatasornarrowcomplex

Pre-excitedAF

consideramiodarone

PolymorphicVT

(e.g.torsadesdepointes-

givemagnesium2

gover10min)

IVentricularTachycardia

(oruncertainrhythm):

Amiodarone300mgIVover20-6

0

min;then900mgover24h

Ipreviouslyconfrmed

SVTwithbundlebranchblock:

Giveadenosineasorregular

narrowcomplextachycardia

*Attemptedelectricalcardioversionisalwaysundertakenundersedationor

generalanaesthesia

See

kexperthelp

Yes

No

Unstable

Irregular

Regular

Narrow

Broad

Stable

Regular

Irregular

IsQRSnarrow(0

.12sec)?

Seekexperthelp

10

Assess using the ABCDE approach

Ensure oxygen given and obtain IV access

Monitor ECG, BP, SpO2

,record 12 lead ECG

Identiy and treat reversible causes (e.g. electrolyte abnormalities)

Risk o asystole?

Recent asystole

Mbitz II AV block Complete heart block with broad QRS

Ventricular pause% 3s

Atropine500 mcg IV

Satisactory

Response?

Assess or evidence o adverse signs:

1 Shock

2 Syncope

3 Myocardial ischaemia

4 Heart ailure

Interim measures:

Atropine 500 mcg IV repeatto maximum o 3 mg

Isoprenaline 5 mcg min-1

Adrenaline 2-10 mcgmin-1

Alternative drugs*OR Transcutaneous pacing

* Alternatives include: Aminophylline

Dopamine

Glucagon (i beta-blocker or calcium channelblocker overdose)

Glycopyrrolate can be used instead o atropine

Bradycardia

Seek expert help

Arrange transvenous pacing

Yes No

Observe

No

No

Yes

Yes


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Unresponsive?

Not breathing or only occasional gasps

Call Resuscitation

Team

(1 min CPR frst, ialone)

CPR (5 initial breaths then 15:2)

Attach defbrillator/monitor

Minimise interruptions

Shockable

(VF/Pulseless VT)

Non-shockable

(PEA/Asystole)

1 Shock 4 J/Kg

Immediately resume:CPR or 2 min


Immediately resume:CPR or 2 min


Return o

spontaneous

circulation

Assess

rhythm

During CPR

Ensure high-quality CPR: rate, depth, recoil Plan actions beore interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenaline every 3-5 min

Consider advanced airway and capnography Continuous chevvst compressions when advanced airway

in place Correct reversible causes

Reversible causes Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia

Tension pneumothorax Toxins Tamponade - cardiac Thromboembolism

Immediate post cardiacarrest treatment

Use ABCDE approach Controlled oxygenation andventilation

Investigations Treat precipitating cause Temperature control Therapeutic hypothermia?

Paediatric Advanced Lie Support

18

Dry the baby

Remove any wet towels and coverStart the clock or note the time

I gasping or not breathing

Open the airwayGive 5 ination breaths

Consider SpO2 monitoring

I chest not moving

Recheck head position

Consider two-person airway controlor other airway manoeuvres

Repeat ination breathsConsider SpO2 monitoring

Look or a response

Reassess heart rate

every 30 secondsI the heart rate is not detectable or slow (# 60)

Consider venous access and drugs

I no increase in heart rate

Look or chest movement

When the chest is moving

I the heart rate is not detectable or slow (# 60)

Start chest compressions3 compressions to each breath

Newborn Lie Support

AT

ALLSTAGESASK:

DOYOUNEEDHEL

P?

Acceptable*

pre-ductal SpO2

2 min : 60%

3 min : 70%

4 min : 80%

5 min : 85%

10 min : 90%

Assess (tone),breathing and heart rate

30 sec

60 sec

Birth

Re-assess

I no increase in heart rate

Look or chest movement


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Full members electronic version only ( 115 or 12 months) enjoy:

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These benefts add to all the benefts you experienced as a web member:

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IMPORTANT

ERC currently oers combined membership possibilities with a number o

organisations, with an additional discount: Belgian Resuscitation Council,

Norwegian Resuscitation Council, Resuscitation Council UK.

I you are already a member o one o these organisations, please contact

their secretariat or additional inormation about combined membership

possibilities.

www.erc.edu

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