ALS and BLS Resuscitation

What is the initial assessment?

Ensure both personal and scene safety

DR ABC

What the algorithm for a shockable rhythm?

1 immediate shock

CPR for 2 minutes before a rhythm check

After 3rd shock give amiodarone and 1mg adrenaline IV and if in refractory VF place new pads in anterior-posterior position

Continue adrenaline every 3-5 minutes

After 5th shock give 150mg amiodarone

What is the algorithm for an unshockable rhythm?

Resume CPR for 2 minutes

Perform a rhythm check

Give adrenaline 1mg every 3-5 minutes

What are the shockable rhythms?

pulseless Ventricular Tachycardia and Ventricular Fibrillation

What are the non-shockable rhythms?

asystole, pulseless electrical activity

What is the BLS ratio?

30:2 in adults

5 breathes then 15:2 in paeds

What are the 6 Ps of defibrillation safety?

Perspiration

Pacemakers

Patches

Piercings

Puddles

Explosives

What is the stepwise approach for airways?

head tilt, chin lift

jaw thrust

OPA/NPA

iGel

Endotracheal intubation

What are the 4 Hs?

Hypoxia, Hypovolaemia, Hypokalaemia/glycaemia, Hypothermia

What is the algorithm for hypoxia?

High concentration oxygen, such as in all patients in cardiac arrest

What is the algorithm for hypovolaemia?

Prioritise controlling catastrophic haemorrhage

Rapidly restore intravascular volume with up to 2L IV/IO saline fluid

Consider early transportation

What is the algorithm for hypoglycaemia/kalaemia?

consider medical history, e.g. Diabetes, eating disorders, gastric disease

BM should be monitored during the arrest and ROSC, IV/IO samples are acceptable

Administer IV glucose if indicated

Undertake a time-critical transfer if hypokalaemia is suspected

What is the algorithm for hypothermia?

look for signs of life for up to 1 minute

prevent further heat loss by removing wet clothes, protecting against wind chill, etc.

If temp is under 30 give a single dose of 1:10,000 adrenaline and amiodarone with a maximum of three shocks

If temp is 30-35 give adrenaline 1:10,000 every 6-10 minutes and standard amiodarone

What are the four Ts

Toxins, tension pneumothorax, thrombosis, tamponade

What is the algorithm for toxins?

Prioritise crew safety around contamination

Rapid conveyance to ED with pre-alert if unknown toxin

Overdose/poisoning should be transported with resus en route

Prolonged resus may be appropriate as good neurological outcome is possible

Naloxone may be considered following opioid overdose with respiratory/hypoxic arrest

What is the algorithm for tension pneumothorax?

Treat early with needle thoracentesis

High suspicion in asthma/trauma patients

What is the algorithm for thrombosis?

If coronary follow ALS algorithm

If pulmonary use the history to help diagnose and undertake a time-critical transfer

What is the algorithm for tamponade?

undertake a time-critical transfer

What is tamponade?

Compression of the heart preventing adequate filling and ejection, leading to cardiac arrest

Often due to a build up of fluid, blood, or gas in the pericardial sac.

Triggers include trauma

What are signs of hypovolaemia?

Thirst and dryness, dizziness, exhaustion, muscle cramping, fainting

A rapid and weak pulse, low blood pressure

Rapid, shallow, or accelerated breathing

Cyanosis, cold/clammy skin

Confusion, agitation

Little to no urine output

Haemorrhage

What are signs of hypoglycaemia?

sweating, shaking, palpitations

headache, nausea

confusion, speech difficulty, drowsiness, odd behaviour, aggression

seizures

hx of diabetes

What are signs of hypokalaemia?

Often asymptomatic

Skeletal muscle weakness, lethargy, muscle cramps, paraesthesia, numbness

Dyspnoea, respiratory failure

Smooth muscle weakness, constipation, nausea, vomiting

Cardiac arrhythmias, e.g. bradycardia, premature atrial and ventricular beats, atrioventricular block, ventricular tachycardia, VF

What are signs of hypothermia?

shivering, cold/pale/dry skin, cyanosis

slurred speech

slow and shallow breathing, bradycardia

tiredness, confusion, poor coordination

What are signs of tension pneumothorax?

high suspicion in trauma or patients with asthma, esp. penetrating trauma/blunt or crushing injuries to the chest

Rapid increase in breathlessness and extreme respiratory distress (resp. rate 30+), with subsequent deterioration to resping under 10 before arresting

One sided chest movement, one sided chest hyperexpansion, reduced air entry on the effected side

Displaced trachea/apex beat

Hyperresonance

What are signs of tamponade?

signs of hypovolaemic shock

tachycardia, hypotension

blunt/penetrating chest trauma

distended neck veins, muffled heart sounds

What are signs of pulmonary thrombosis?

dyspnoea, resp rate 20+

cough, haemoptysis

tachycardia

sats under 92

pleuritic chest pain, substernal chest pain

What are signs of coronary thrombosis?

cardiac chest pain radiating to the jaw, neck, or shoulder

epigastric discomfort

nausea, vomiting, sweating, dyspnoea, pallor

feeling of impending doom