The Resuscitation Guidelines 2005

The slides here are modified from the 2005 Resuscitation Council (UK) Guidelines for the Management of Adult Cardiac Arrest. They have been prepared for the University of Dundee Medical Students.

…. to confirm cardiac arrest

• Patient response• Open airway• Check for normal

breathing– caution agonal breathing

• Check for signs of life

Open Airway Look for signs of life

…. to confirm cardiac arrest

• Pulse check if trained to do so

• Take no more than 10 seconds for assessment of both breathing and pulse.

Open Airway Look for signs of life

CPR 30:2Until defibrillator / monitor attached

Check 123,

ABC

Call Ambulance orResuscitation Team

Cardiac arrest confirmed

Chest compression• 30:2 • Compressions

– “Centre of chest”– 4-5 cm depth– 100 min-1

• Uninterrupted compressions when airway secured

• Avoid– Provider fatigue– Interruptions

CPR 30:2Until defibrillator/monitor attached

AssessRhythm

Open Airway Look for signs of life

Call Resuscitation Team

ALSAlgorithm

How to assess ECG rhythm?

• ECG monitoring leads

• Self-adhesive electrodes

• ‘Quick-look’ paddles

ECG monitoring leads

• 3-lead system approximates to I, II, III

• Colour coded• Remove hair• Apply over bone• Lead setting (II)

Self-adhesive electrodes

• Hands-free • Remove excess chest

hair• Dry chest if necessary• Continue CPR whilst

applying

‘Quick-look’ paddles

• Hold still• Apply firm pressure• Use coupling agent –

gel pads

If using an automated external defibrillator (AED)

• When AED arrives switch on

• Follow voice and visual prompts

• Perform other skills according to your training e.g. pocket mask ventilation, IV access, drugs

Shockable Rhythms(VF/Pulseless VT)

CPR 30:2Until defibrillator/monitor attached

AssessRhythm

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

Open Airway Look for signs of life

Call Resuscitation Team

ALSAlgorithm

Precordial thump

– Rapid treatment of a witnessed and monitored VF/VT cardiac arrest

– Use if defibrillator not immediately available

Shockable Rhythm(VF/Pulseless VT)

1 Shock150 – 360J Biphasic

360J Monophasic

Immediately ResumeCPR 30:2For 2 min

Still a Shockable Rhythm(VF/Pulseless VT)

1 Shock150 – 360J Biphasic

360J Monophasic

Immediately ResumeCPR 30:2For 2 min

1

2

Still a Shockable Rhythm(VF/Pulseless VT)

Give 1 mg Adrenaline IV

1 Shock150 – 360J Biphasic

360J Monophasic

Immediately ResumeCPR 30:2For 2 min

Still a Shockable Rhythm(VF/Pulseless VT)

Give 300 mg Amiodarone IV

1 Shock150 – 360J Biphasic

360J Monophasic

Immediately ResumeCPR 30:2For 2 min

3

4

VF/Pulseless VT

• Check pulse if– Organised rhythm seen after 2 min CPR– Patient showing signs of life

• Adrenaline 1mg IV every 2 loops– Just before alternate shocks

• Amiodarone given once only

Defibrillation energies

• Vary with manufacturer

• Check local equipment

• If unsure, deliver 200 J (do not delay shock)

• Energy levels for defibrillators in this hospital/university 360 J monophasic (150 Joules for biphasic models)

Non-shockable RhythmsPEA/Asystole

CPR 30:2Until defibrillator/monitor attached

AssessRhythm

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

Open Airway Look for signs of life

Call Resuscitation Team

ALSAlgorithm

Non-Shockable Rhythm (PEA/Asystole)

Immediately Resume CPR 30:2 For 2 min

Give 1mg Adrenaline IV

Still a Non-Shockable Rhythm

(PEA/Asystole)

Immediately Resume CPR 30:2 For 2 min

PEA/Asystole

• Check pulse if– A change to an organised rhythm seen

after 2 min CPR– Patient showing signs of life

• Adrenaline 1mg IV every 2 loops as soon as IV access is achieved

• In asystole and PEA (heart rate <60) Atropine 3mg is given once only

During CPR: Correct reversible causes Check electrode position and

contact Attempt/verify:

IV accessAirway and oxygen

Give uninterruptedcompressions when airwaysecure

Give adrenaline every 3–5 min. Consider: amiodarone,

atropine, magnesium

Airway and ventilation

• Secure airway:– tracheal tube– LMA

• Once airway secured, if possible, do not interrupt chest compressions for ventilation

• Avoid hyperventilation

Reversible CausesHypoxia Tension pneumothoraxHypovolaemia Tamponade, cardiacHypo/hyperkalaemia/metabolic ToxinsHypothermia Thrombosis (coronary or pulmonary)

• Any Questions regarding cardiopulmonary resuscitation can be referred to Susan Somerville, Resuscitation Officer, University of Dundee, via email:

• s.g.somerville@dundee.ac.uk