Download - Algoritmos RCP 2010
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Fig 1.2_Adult BLS Final
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 112*
2 rescue breaths30 compressions
30 chest compressions
Adult Basic Life Support
UNRESPONSIVE?
*or national emergency number
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Fig 1.4_BLS-AED Final
unresponsive?
Call for help
Send or go for AEDCall 112*
Open airwayNot breathing normally
CPR 30:2until AED is attached
Shockadvised
No shockadvised
1 Shoc
Immediately resme:CPR 30:2for 2 min
Immediately resme:CPR 30:2for 2 min
Contine ntil the victim startsto wae p: to move, opens
eyes and to breathe normally
AED
assessesrhythm
*or national emergency nmber
Automated External Defibrillator Algorithm
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Fig 1.3_Adult FBAO Final
Assess severity
Mild airway obstruction(effective cough)
Severe airway obstruction(ineffective cough)
Unconscious
Start CPR
Conscious
5 back blows5 abdominal thrusts
Encourage cough
Continue to checkfor deterioration
to ineffective cough oruntil obstruction relieved
Adult Foreign Body Airway Obstruction Treatment
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Fig 1.5_InHospital Resuscitation Final
Collapsed/sick patient
Shout for HELP & assess patient
Assess ABCDERecognise & treat
Oxygen, monitoring, iv access
Call resuscitation teamIf appropriate
Handover to resuscitation team
Call resuscitation team
CPR 30:2with oxygen and airway adjuncts
Apply pads/monitorAttempt debrillation if appropriate
Advanced Life Supportwhen resuscitation team arrives
In Hospital Resuscitation
No YesSigns of life?
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Fig 1.6_Adlt ALS Final
unresponsive?Not breathing or only occasional gasps
CallResscitation Team
CPR 30:2Attach defibrillator/monitor
Minimise interrptions
Shockable(VF/Pulseless VT)
Non-shockable(PEA/Asystole)
1 Shoc
Immediately resme:CPR for 2 min
Minimise interrptions
Immediately resme:CPR for 2 min
Minimise interrptions
Retrn ofspontaneos
circlation
Assessrhythm
During CPR
Ensre high-qality CPR: rate, depth, recoil Plan actions before interrpting CPR
Give oxygen Consider advanced airway and capnography Continos chest compressions when advanced airway in place Vasclar access (intravenos, intraosseos) Give adrenaline every 3-5 min Correct reversible cases
Reversible causes
Hypoxia Hypovolaemia
Hypo-/hyperalaemia/metabolic Hypothermia
Thrombosis Tamponade - cardiac Toxins Tension pnemothorax
Immediate post cardiac
arrest treatment
use ABCDE approach Controlled oxygenation and
ventilation 12-lead ECG Treat precipitating case Temperatre control / therapetic
hypothermia
Advanced Life Support
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Fig 1.8_Bradycardia Final
Assess sing the ABCDE approach
Ensre oxygen given and obtain IV access
Monitor ECG, BP, SpO2 ,record 12 lead ECG
Identify and treat reversible cases (e.g. electrolyte abnormalities)
Risk of asystole? Recent asystole
Mbitz II AV bloc Complete heart bloc with broad QRS Ventriclar pase > 3s
Atropine
500 mcg IV
SatisfactoryResponse?
Assess for evidence of adverse signs:1 Shoc2 Syncope3 Myocardial ischaemia4 Heart failre
Interim measures: Atropine 500 mcg IV repeat to maximm of 3 mg Isoprenaline 5 mcg min-1
Adrenaline 2-10 mcg min-1
Alternative drgs*
OR Transctaneos pacing
* Alternatives inclde:
Aminophylline Dopamine Glcagon (if beta-blocer or calcim channel
blocer overdose) Glycopyrrolate can be sed instead of atropine
Bradycardia Algorithm
See expert helpArrange transvenos pacing
No
Yes No
Yes
Observe
No
Yes
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Fig 1.9_ACS Defnitons Final
Patient with clinical signs and symptoms of ACS
= NSTEMI if troponins(T or I) positive
= UAP if troponinsremain negative
STEMI
ST elevation 0.1 mV in 2 adjacent limb leads and/
or 0.2 mV in adjacent chest leadsor (presumably) new LBBB
Other ECG alterations(or normal ECG)
12 lead ECG
non-STEMI-ACSHigh risk dynamic ECG changes ST depression haemodynamic/rhythm instability diabetes mellitus
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Fig 1.10_ACS Treatment Final
Pain relief Nitroglycerin sl if systolic BP> 90 mmHg Morphine (repeated doses) of 3-5 mg until pain free
Antiplatelet treatment 160-325mg Acetylsalicylic acid chewed tablet (or iv)75 600 mg Clopidogrel according to strategy*
Early invasive strategy#
UFH
Enoxaparin or bivalirudin may be considered
Conservative
or delayed invasive strategy#
UFH (fondaparinux or bivalirudin may be
considered in pts with high bleeding risk)
STEMI
Thrombolysis preferred if
no contraindications and
inappropriate delay to PCI
Adjunctive therapy:
UFH, enoxaparin or fondaparinux
PCI preferred if
timely available in a high volume center
contraindications for brinolysis
cardiogenic shock (or severe left
ventricular failure)
Adjunctive therapy:
UFH, enoxaparin or bivalirudin may be
considered
ECG
Non-STEMI-ACS
# According to risk stratication
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Fig 1.11_Paed BLS Final
Shout for help
Open airway
NOT BREATHING NORMALLY?
5 rescue breaths
2 rescue breaths30 compressions
NO SIGNS OF LIFE?
30 chest compressions
Paediatric basic life support
UNRESPONSIVE?
After 1 minute of CPR call 112 or national emergency number
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Fig 1.12_Paed FBAO Final
Assess severity
Effective coughIneffective cough
Unconscious
Open airway5 breathsStart CPR
Conscious
5 back blows5 thrusts
(chest for infant)
(abdominal for child> 1 year)
Encourage cough
Continue to check fordeterioration to ineffectivecough or until obstruction
relieved
Paediatric Foreign Body Airway ObstructionTreatment
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Fig 1.13 Paed ALS Final
unresponsive?Not breathing or only occasional gasps
Call ResscitationTeam
(1 min CPR first, if alone)
CPR (5 initial breaths then 15:2)Attach defibrillator/monitor
Minimise interrptions
Shockable(VF/Pulseless VT)
Non-shockable(PEA/Asystole)
1 Shoc 4 J/kg
Immediately resme:CPR for 2 min
Minimise interrptions
Immediately resme:CPR for 2 min
Minimise interrptions
Retrn ofspontaneos
circlation
Assessrhythm
During CPR
Ensre high-qality CPR: rate, depth, recoil Plan actions before interrpting CPR
Give oxygen Vasclar access (intravenos, intraosseos) Give adrenaline every 3-5 min Consider advanced airway and capnography Continos chest compressions when advanced airway in place Correct reversible cases
Reversible causes
HypoxiaHypovolaemia
Hypo-/hyperalaemia/metabolic Hypothermia
Tension pnemothorax Toxins Tamponade - cardiac Thromboembolism
Immediate post cardiac
arrest treatment
use ABCDE approach Controlled oxygenation and
ventilation Investigations Treat precipitating case Temperatre control Therapetic hypothermia?
Paediatric Advanced Life Support
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Dry the babyRemove any wet towels and cover
Start the cloc or note the time
If gasping or not breathingOpen the airway
Give 5 ination breathsConsider SpO2 monitoring
If chest not moving
Rechec head position
Consider two-person airway controlor other airway manoevresRepeat ination breaths
Consider SpO2 monitoring
Loo for a response
Reassess heart rateevery 30 seconds
If the heart rate is not detectable or slow (< 60)Consider venos access and drgs
If no increase in heart rateLoo for chest movement
When the chest is movingIf the heart rate is not detectable or slow (< 60)
Start chest compressions3 compressions to each breath
Newborn Life Support
ATA
LLSTAGE
SASk:D
OY
OuN
EEDHELP?
Acceptable*
pre-ductal SpO2
2 min : 60%3 min : 70%
4 min : 80%
5 min : 85%
10 min : 90%
Assess (tone),breathing and heart rate
30 sec
60 sec
Birth
Re-assess
If no increase in heart rate
Loo for chest movement