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ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of.

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Presentation on theme: "ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of."— Presentation transcript:

1 ALS

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

5

6 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 Confirm cardiorespiratory arrest

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)

9

10 Rhythm ? – Shockable or Non- Shockable

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

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

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

18 CORRECT REVERSIBLE CAUSES 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 2 nd 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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