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Presentation on theme: "ALS."— Presentation transcript:


2 Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms
- shockable ryhthms - non-shockable rhythms Potential reversible causes of cardiac arrest Safe debrillation (Zoll and AED) Practice ALS scenarios

3 Early recognition of the critically ill patient
Most arrests are predictable Deterioration prior to % of cardiac arrests Hypoxia and hypotension are common antecedents Delays in referral to higher levels of care

4 Early recognition prevents:
Call for help early!!!!! Early recognition prevents: Cardiac arrests and deaths Admissions to ICU, inappropriate resuscitations


6 Confirm cardiorespiratory arrest
Check for danger Check for response - if unresponsive Call for help/met call – 666 at Liverpool Open airway Check for normal breathing Start CPR – 30 chest compressions, then 2 breaths (30:2) Attach AED/defib

7 Basic Life Support Compressions lower ½ sternum
>/= 5 cm depth (1/3 depth chest) 100 min-1 Ratio 30:2 breaths until airway secured Avoid! Interruptions (<10 seconds) Provider fatigue (swap every cycle)

8 Airway and ventilation
Oxygenation important NOT intubation No evidence that intubation improves outcome (& may interrupt compressions) Open airway, place Guedel then Bag-Valve mask ventilation is ok initially Met 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.


10 Rhythm ? – Shockable or Non-Shockable

11 Shockable Ventricular Fibrillation: Bizarre irregular waveform
No recognisable QRS complexes Random frequency and amplitude Uncoordinated electrical activity

12 Rhythm ? – Shockable or Non-Shockable

13 Shockable VT (monomorphic) broad complex regular rhythm rapid rate
constant QRS morphology

14 Defibrillation Must be safe – live current!! –all hands off patient, 02 away Energy varies with manufacturer - Check local equipment Biphasic (Zoll) give 200 J standard (can alter energy level manually) AED – automatic – set at 200J Must do 2 mins CPR after any shock before checking rhythm

15 Rhythm ? – Shockable or Non-Shockable

16 Non-shockable Asystole: Absent ventricular (QRS) activity
Atrial activity (P waves) may persist Rarely a straight line trace

17 Non-shockable Pulseless electrical activity:
Clinical features of cardiac arrest ECG normally associated with an output

Hypoxaemia Hypovolaemia Hypo/hyperthermia Hypo/hyperkalaemia & other metabolic disorders Tamponade Tension pneumothorax Toxins / Poisons / Drugs Thrombus - pulmonary / coronary

19 Adrenaline Dose: 1mg IV VF/VT – give after 2nd shock
Non VF/VT – give immediately Repeat every 3-5 min ie alternate cycles

20 Any questions

21 Summary ALS algorithm provides a standardised approach to the treatment of cardiac arrest in adults Shockable rhythms (VF/pulseless VT) Non-shockable rhythms Reversible causes of cardiac arrest Common drugs used

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