2Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms- non-shockable rhythmsPotential reversible causes of cardiac arrestSafe debrillation (Zoll and AED)Practice ALS scenarios
3Early recognition of the critically ill patient Most arrests are predictableDeterioration prior to % of cardiac arrestsHypoxia and hypotension are common antecedentsDelays in referral to higher levels of care
4Early recognition prevents: Call for help early!!!!!Early recognition prevents:Cardiac arrests and deathsAdmissions to ICU, inappropriate resuscitations
6Confirm cardiorespiratory arrest Check for dangerCheck for response - if unresponsiveCall for help/met call – 666 at LiverpoolOpen airwayCheck for normal breathingStart CPR – 30 chest compressions, then 2 breaths (30:2)Attach AED/defib
7Basic Life Support Compressions lower ½ sternum >/= 5 cm depth (1/3 depth chest)100 min-1Ratio 30:2 breaths until airway securedAvoid!Interruptions (<10 seconds)Provider fatigue (swap every cycle)
8Airway and ventilation Oxygenation important NOT intubationNo evidence that intubation improves outcome (& may interrupt compressions)Open airway, place Guedel then Bag-Valve mask ventilation is ok initiallyMet team may consider advanced airway: LMA (or ETT)Avoid hyperventilation (6-10/min max)Avoiding hyperventilation refers to making sure that large volumes and high rates are not used as these will increase intrathoracic pressure, reducing venous return and coronary perfusion.
14DefibrillationMust be safe – live current!! –all hands off patient, 02 awayEnergy varies with manufacturer - Check local equipmentBiphasic (Zoll) give 200 J standard (can alter energy level manually)AED – automatic – set at 200JMust do 2 mins CPR after any shock before checking rhythm
21SummaryALS algorithm provides a standardised approach to the treatment of cardiac arrest in adultsShockable rhythms (VF/pulseless VT)Non-shockable rhythmsReversible causes of cardiac arrestCommon drugs used