als. objectives prevention of cardiac arrest revision of bls als algorithms - shockable ryhthms -...

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Page 1: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

ALS

Page 2: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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

Page 3: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Early recognition of the critically ill patient

• Most arrests are predictable

• Deterioration prior to 50 - 80% of cardiac arrests

• Hypoxia and hypotension are common antecedents

• Delays in referral to higher levels of care

Page 4: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Call for help early!!!!!

Early recognition prevents:• Cardiac arrests and deaths• Admissions to ICU, inappropriate

resuscitations

Page 5: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of
Page 6: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

• 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

Page 7: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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)

Page 8: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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)

Page 9: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of
Page 10: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Rhythm ? – Shockable or Non-Shockable

Page 11: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Ventricular Fibrillation:• Bizarre irregular

waveform• No recognisable QRS

complexes• Random frequency and

amplitude

• Uncoordinated electrical activity

Shockable

Page 12: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Rhythm ? – Shockable or Non-Shockable

Page 13: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Shockable

• VT (monomorphic)– broad complex regular rhythm– rapid rate– constant QRS morphology

Page 14: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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

Page 15: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Rhythm ? – Shockable or Non-Shockable

Page 16: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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

Non-shockable

Page 17: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Pulseless electrical activity:• Clinical features of cardiac arrest• ECG normally associated with an output

Non-shockable

Page 18: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

CORRECT REVERSIBLE CAUSES

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

Page 19: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Adrenaline Dose: 1mg IV– VF/VT – give after 2nd shock

– Non VF/VT – give immediately

– Repeat every 3-5 min

ie alternate cycles

Page 20: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

Any questions

Page 21: ALS. Objectives Prevention of cardiac arrest Revision of BLS ALS algorithms - shockable ryhthms - non-shockable rhythms Potential reversible causes of

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