1. Advanced Cardiac Resuscitation GuidelinesBy
Muhammad Bayat

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

3. 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

4. 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

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

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

7. 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

8. 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

9. 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

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

11. 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

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

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

14. 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).

15. 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

16. 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.

17. ECG RHYTHMN REGONITION
Ventricular Fibrillation
Asystole

19. 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

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

21. 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

22. 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

23. 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

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

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

26. 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