advanced cardiac resuscitation guidelines by muhammad bayat
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Advanced Cardiac Resuscitation Guidelines
By
Muhammad Bayat
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BLS- HAZARDS
• Hazards- Make sure the scene is safe for you to help.
Make sure you have universal precautions: gloves, Face Mask, and Apron
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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
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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
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BLS - Breathing
• LOOK-LISTEN-&-FEELING for breaths
• CHECK REATHING FOR 5-10 SECONDS.
• If they isn’t breathing VENTILATE TWICE -Rescue Breathing
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BLS- Circulation Check
• Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.
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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
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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
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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
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ALS AIRWAY EQUIPMENT
• 1" ribbon gauze/tape
• Scissors
• Syringe - 20 mls
• Oxygen cylinders x 2 (if no wall oxygen)
• KY Jelly
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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
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Basic ALS Drugs
• DRUGS
• Adrenaline / Epinephrine 1 mg (1:1000)
• Atropine 3 mgs
• Amiodarone 300mgs
• Phenergan
• Hydrocortisone
• Lignocaine
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ALS - Additional Equipment
ADDITIONAL ITEMS
• ECG Electrodes
• Defibrillation Gel pads
• Pulse Oximeter
• Gloves/Goggles/Aprons
• NIBP Monitor
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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).
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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
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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.
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ECG RHYTHMN REGONITION
• Ventricular Fibrillation
• Asystole
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ALS- Defibrillation
• 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
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ALS- Advanced Airway
• Prepare Equipment• Insert Airway• Check Position• Ventilate• Consider Surgical
Airway -Cricothyroidotomy
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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
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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
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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
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Anaphylaxis
Clinical Features• Urticaria (hives)
and/or angioedema• Hypotension -Shock• Upper Resp Tract
Obstruction.• Bronchospasm• Cyanosis
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Anaphylaxis-Treatment
• Prevention
• ALS- Airway Protection,Breathing, Circulation
• Adrenaline (0.5ml IMI & Nebulised & IV)
• Antihistamines (Promethazine 25mg)
• Adrenergic Agonists (Salbutamol Nebs)
• Hydrocortisone (200mg IVI)
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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