erc guidelines of resuscitation
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ERC Guidelines of ResuscitationTRANSCRIPT
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ERC Guidelines of Resuscitation 2010
MAIN CHANGES
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Adult BLS Algorhythm
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Adult BLS Algorhythm
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Main changes in basic life support• The decision to start CPR is made is made if a victim is unresponsive and not breathing normally
• Place hands on the centre of the chest, Rather than using the ‘rib margin’ method
• The ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest
• Same ratio should also be used for children when attended by a lay rescuer
• For an adult victim, the 2 initial rescue breaths are omitted, with 30 compressions being given immediately after cardiac arrest is established
• Each rescue breath is given over 1 sec rather than 2 sec
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AEDAutomated External Defibrilators• Public access defibrilation (PAD) for
locations where the use of AED for witnessed cardiac arrest exceeds once in two years
• Single defibrilatory shock (at least 150J monophasic / 360J biphasic)
• Followed by 2 min uninterrupted CPR (without check for termination of VF or a check for signs of life or pulse)
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Main Changes in Adult Advanced Life Support
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CPR Before Defibrillation
• In out-of-hospital cardiac arrest, give CPR for 2 min (i.e. about 5 cycles at 30:2) before defibrillation
• Do not delay defibrillation if an out-of –hospital arrest is witnessed by a healthcare professional
• Do not delay defibrillation for in–hospital cardiac arrest
• Precordial thump
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Defibrillation strategy
• Treat VF/VT with a single shock• Followed by immediate resumption of
CPR (30:2)• Do not reassess rhythm or feel for a
pulse• After 2 min of CPR, check the
rhythm and give another shock (if indicated)
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Defibrillation strategy
• The recommended initial energy for Biphasic defibrillators is 150 – 200 J
• Give second and subsequent shocks at 150 – 360 J
• The recommended energy when using a monophasic defibrillator is 360 J for the initial and subsequent shocks
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Fine VF
• If there is doubt about whether the rhythm is asystole or fine VF, do NOT attempt defibrillation
• Instead, continue chest compressions and ventilation
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Adrenaline (epinephrine)
• VF/VT Give adrenaline 1 mg if VF/VT persists
after a second shock Repeat the adrenaline every 3-5 min
thereafter if VF/VT persists• Pulseless electrical activity /
asystole Give adrenaline 1 mg as soon as IV
access is obtained Repeat every 3-5 min thereafter until
return of spontaneous circulation
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Anti-arrhythmic drugs
• If VF/VT persists after three shocks, give amiodarone 300mg by bolus injection
• A further dose of 150mg may be given for recurrent or refractory VF/VT, followed by an infusion of 900mg over 24 h
• If amiodarone is not available, Lidocaine 1mg/kg (max 3mg/kg in first hour) may be used as an alternative ~ but do not give if amiodarone has already been given
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Anti-arrhythmic drugs (contd..)• MgSO4 recommended only if
refractory VF due to hypomagnesemia
• If rhythm is asystole / PEA– Continuous CPR– Adrenaline– Atropine (in a dose of 500mcg boluses
up to a dose of 3mg)
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Thrombolytic therapy for cardiac arrest
• When thought to be due to proven or suspected pulmonary embolus
• Following failure of standard resuscitation in patients with suspected acute thrombotic aetiology for the arrest
• Consider performing CPR for 60-90 min when Thrombolytic agents have been given during CPR
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Post Resuscitation care – Therapeutic hypothermia
• Unconscious adult patient, with spontaneous circulation, after out-of-hospital cardiac arrest should be cooled to 32-34 C for 12-24 h
• Mild hypothermia may also benefit unconscious adult patients, with spontaneous circulation, after out-of-hospital arrest from a non-shockable rhythm or after cardiac arrest in hospital
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Peri-Arrest Arrhythmias – Guideline Changes
• The Bradycardia algorhythm is virtually unchanged
• Broad-complex tachycardia, Narrow-complex tachycardia, and atrial fibrillation have been combined into a single tachycardia algorhythm (as they have many common principles in the peri-arrest setting
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Main Changes in Paediatric Life Support
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Paediatric Basic Life Support
• For lay / Lone rescuers 5 rescue breaths 30 compressions to 2 ventilations (as taught in
adult BLS)
• Two or more rescuers with a duty to respond 15 :2 ratio in a child (up to the onset of puberty)
• In infant : compression technique single rescuer – two finger technique two rescuers – two thumb encircling technique
• Above one yearNo division between one and two hand technique
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Paediatric Basic Life Support (contd..)
• AED maybe used in children above one year of age
• Attenuators of the electrical output are recommended between 1 and 8 years of age
• For foreign body obstruction relief : attempt 5 rescue breaths (to relieve Hypoxia) In the absence of response, proceed to chest
compressions without further assessment of the circulation (2min of CPR)
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Paediatric advanced life support• The Laryngeal Mask Airway is an
acceptable initial airway device for providers experienced in its use
• In hospital, a cuffed tracheal tube maybe useful in certain circumstances (cuff inflation pressure should remain below 20 cm H2O)
• The ideal tidal volume should achieve modest chest rise i.e. 6-7ml/Kg (hyperventilation is harmful)
• When using a manual defibrillator, a dose of 4J/kg (biphasic or monophasic) should be used for the first and subsequent shocks
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Asystole, pulseless electrical activity (PEA)
• Adrenaline IV or IO should be given at the dose of 10 mcg/kg and repeated every 3-5 min
• If no vascular access is available and a tracheal tube is in-situ, adrenaline may be given at the dose of 100 mcg/kg via this route until IV/IO access is obtained
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Defibrillation strategy
• VF/VT should be treated with a single shock(4J/Kg) or AED (attenuated as appropriate)
• Followed by immediate resumption of CPR (15:2)
• Do not reassess the rhythm or feel for a pulse.
• After 2 min of CPR, check the rhythm and give another shock (if indicated)
• Give adrenaline 10 mcg/kg IV if VF/VT persists after a second shock
• Repeat adrenaline every 3-5 min thereafter if VF/VT persists
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Temperature control
• After cardiac arrest treat fever aggressively
• A child who regains a spontaneous circulation but remains comatose may benefit from being cooled to a core temperature of 32-34 C for 12-24h
• After a period of mild hypothermia, the child should be warmed slowly at 0.25-0.5 C / hour
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Take Home Message
• Early ACCESS – to get help• Early CPR – to buy time• Early DEFIBRILATION – to restart
heart• Early ALS – to stabilize
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Take Home Message
• Reduce “NO-FLOW” time
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