1. 1.4
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2. Management of Surgical Emergencies Part 1 : Critical Care
Advanced Life Support: Principles & Recent Changes
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3. Aims Principles Changes in ALS Post-resuscitation care
BLS demonstration
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4. Resuscitation - Futile or not?
May be inappropriate due to injury, pre- existing conditions or lack of available resources – senior clinician involvement
Not always futile
Potentially reversible and treatable conditions especially in context of trauma
Good quality ALS buys time…
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5. Principles of ALS Early recognition of the deteriorating patient
Early decision making – appropriate?
Usually predictable
Structured assessment – A,B,C,D,E
Good quality BLS - chest compressions, oxygenation and ventilation
Reversible causes?
Post-resuscitation care - A,B,C,D,E
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8. BLS Collapsed patient - SAFE approach Unresponsive - get help
Responsive - A,B,C,D assessment
Open airway - head tilt, chin lift / jaw thrust
Airway adjunct
Look, listen, feel 10s. Signs of life?
No signs of life - start chest compressions
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9. Recent changes Check for signs of life or breathing Compressions:
Centre of chest
5-6cm depth - allow chest to expand fully
Rate per minute
Ratio 30:2 i.e. 30 compressions to two breaths
Ventilation:
Ideally with airway adjunct and BVM; pocket mask
Once definitive airway inserted:
Continuous compressions -10 breaths per minute
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10. Adult ALS Algorithm
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11. Monitor or Defibrillator (if available) Assess Rhythm
Shockable (VF/VT)
Single DC shock (360J mono, 150J biphasic),
CPR
1mg Adrenaline & 300mg Amiodarone (after 3rd shock)
Adrenaline every 4 mins
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12. Monitor or Defibrillator (if available) Assess Rhythm
Non-shockable (PEA/Asystole)
Continuous CPR.
Rhythm check every 2 minutes
Adrenaline every 4 minutes
During CPR:
Secure airway;
Consider reversible causes
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13. Reversible causes 4 H’s Hypoxia Hypovolaemia Hypothermia
Hypo/hyperkalaemia
4 T’s
Tension Pneumothorax
Tamponade
Thromboembolism
Toxicity
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14. Special Circumstances
Poisoning
Hyperkalaemia
Hypothermia
Drowning
Electrocution
Anaphylaxis
Asthma
Pregnancy
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15. Difficult Decisions Continue or stop
Clinical judgement - past medical history
Assessment of likelihood of achieving ROSC
Confirm death - absence of central pulse on palpation. Absence of heart sounds on auscultation.
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16. Post-resuscitation Care
Aims:
Brain – prevention of secondary injury
Heart - stabilise rhythm and function
Organs - optimise perfusion
Anticipate SIRS type response
Management of precipitating pathology
Reduce morbidity
Consider active cooling (reduce secondary injury)
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17. Post-resuscitation Management
Airway
Protected?
Consider intubation
Breathing & ventilation
Ensure adequate Oxygenation.
Ventilate to Normocapnia
Circulation
Manage Arrhythmias.
Optimise cardiac dysfunction
Monitoring
Disability
Sedation and seizure control
Exposure
Temperature
Glucose control
Cooling - out of hospital VF arrest
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18. Quality & Human Factors
Quality cardiac arrest management requires:
Leadership
Task identification, delegation & prioritisation
Task familiarisation
Team work
Manage conflict
Manage relatives
Debrief
Audit & Quality Improvement
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19. QUESTIONS?
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20. Summary Deterioration usually predictable
Structured approach to assessment
Quality BLS & ALS may be appropriate and buy time
Changes in delivery of BLS
Consider reversible causes
Post-resuscitation care
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21. BLS Demonstration
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