Advanced Cardiac Resuscitation Guidelines By Muhammad Bayat

BLS- HAZARDS Hazards- Make sure the scene is safe for you to help. Make sure you have universal precautions: gloves, Face Mask, and Apron

BLS- HELLO + HELP Determine if the patient is conscious by tapping and shouting "Are you OK?" If no response have someone call for the crash cart

BLS- Airway Position the patient on their back. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver. Suction the airway and clear out any foreign bodies Insert an appropriate sized Guedel airway

BLS - Breathing LOOK-LISTEN-&-FEELING for breaths CHECK REATHING FOR 5-10 SECONDS. If they isn’t breathing VENTILATE TWICE -Rescue Breathing

BLS- Circulation Check Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.

BLS- Circulation If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS for both one and two man CPR

BLS - CPR Recheck the pulse after ONE MINUTE. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE. Approximately 4 cycles will pass before the pulse check

Advanced Life Support Recommended Minimum Equipment for the Management of Adult Cardiopulmonary Arrest AIRWAY EQUIPMENT Self inflating resuscitation bag with oxygen reservoir and tubing -BVM Laryngoscopes x 2 - normal and long blades Spare laryngoscope bulbs and batteries

ALS AIRWAY EQUIPMENT 1" ribbon gauze/tape Scissors Syringe - 20 mls Oxygen cylinders x 2 (if no wall oxygen) KY Jelly

ALS - Equipment CIRCULATION EQUIPMENT Intravenous cannulae 18 gauge x 3, 14 gauge x 3 Hypodermic needles 21 gauge x 10 Syringes 2 mls x 6, 5 mls x 6, 10 mls x 6, 20 mls x 6 Intravenous giving sets IV Infusion Fluid- MRL

Basic ALS Drugs DRUGS Adrenaline / Epinephrine 1 mg (1:1000) Atropine 3 mgs Amiodarone 300mgs Phenergan Hydrocortisone Lignocaine

ALS - Additional Equipment ADDITIONAL ITEMS ECG Electrodes Defibrillation Gel pads Pulse Oximeter Gloves/Goggles/Aprons NIBP Monitor

ALS- Management Heart rhythms associated with cardiac arrest can be divided into two groups: 1.) ventricular fibrillation / pulseless ventricular tachycardia (VF/VT) 2.)Other rhythms. Asystole and pulseless electrical activity (PEA).

ALS -Rhythm Why the Differentiation? The management of these two groups of arrhythmias is different Defibrillation in those patients with VF/VT Drugs used in the other rhythms

ALS- Rhythm Recognition Similarities CPR , Airway management and Ventilation, venous access, the administration of epinephrine (adrenaline) and the identification and correction of contributing factors, are common to both groups.

ECG RHYTHMN REGONITION Ventricular Fibrillation Asystole

ALS- Defibrillation Turn on the Machine Change Lead Select Gel the Paddles Confirm the Rhythm Set Energy level at 200J 3 stacked defibrillation of 200,200,360J

ALS- Advanced Airway Prepare Equipment Insert Airway Check Position Ventilate Consider Surgical Airway -Cricothyroidotomy

ALS- Drug Therapy VENTRICULAR FIBRILLATION Adrenaline Dilute 1mg of 1:1000 adrenaline into 10mls Give 1mg every 3minutes followed by a stacked shock after 1 minute of CPR Maximum dose = 3mg

ALS- Drug Therapy Atropine Used in Asystole and PEA Mech.. Of Action : Vagolytic Drug Given at a dose of 1mg every 3 minutes till a maximum of 3mg

ALS- Drug Therapy Amiodarione Used in persistent VF that remains despite adrenaline Used post 2nd defibrillation attempt 300mgf bolus given mixed with 20ml of dextrose

Anaphylaxis Clinical Features Urticaria (hives) and/or angioedema Hypotension -Shock Upper Resp Tract Obstruction. Bronchospasm Cyanosis

Anaphylaxis-Treatment Prevention ALS- Airway Protection,Breathing, Circulation Adrenaline (0.5ml IMI & Nebulised & IV) Antihistamines (Promethazine 25mg) Adrenergic Agonists (Salbutamol Nebs) Hydrocortisone (200mg IVI)

ALS- Take Home Message Do Not Panic Remember ABC’s Defibrillate only a VF/VT & remember the GEL Adrenaline is common drug to all the protocols