Basic Life Support & Automated External Defibrillation

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1 Basic Life Support & Automated External Defibrillation Check response Shake gently Ask loudly: Are you all right? If not responsive Open airway & check for breathing If not breathing normally or not breathing If breathing normally Call 112, find & bring an AED Start CPR immediately * Turn into recovery position Place your hands in the centre of the chest Deliver 30 chest compressions: Press firmly at least 5 cm deep Call 112 Continue to assess that breathing remains normal at a rate of at least 100/min Seal your lips around the mouth Blow steadily until the chest rises Give next breath when the chest falls Continue CPR CPR 30:2 Switch on the AED & attach pads Follow the voice prompts immediately Attach one pad below the left armpit Attach the other pad below the right collar bone, next to the breastbone If more than one rescuer: don t interrupt CPR Stand clear & deliver shock body should touch the victim - during analysis - during shock delivery If the victim starts to wake up: to move, to open eyes and to breathe normally, stop CPR. If still unconscious, turn him into the recovery position*. Product reference: Poster_10_BLSAED_01_01_ENG Copyright European Resuscitation Council

2 In-hospital Resuscitation Collapsed/sick patient Shout for HELP & assess patient If NO signs of life If signs of life Call team Assess ABCDE Recognise & treat CPR 30:2 Oxygen, monitoring, iv access with oxygen and airway adjuncts Call team If appropriate Apply pads/monitor Handover to team Attempt defibrillation if appropriate when team arrives Product reference: Poster_10_IHBLS_01_01_ENG Copyright European Resuscitation Council

3 In-hospital Resuscitation Collapsed/sick patient Shout for HELP & assess patient Signs of life? Call team CPR 30:2 with oxygen and airway adjuncts Assess ABCDE Recognise & treat Oxygen, monitoring, iv access Apply pads/monitor Attempt defibrillation if appropriate Call team If appropriate when team arrives Handover to team Product reference: Poster_10_IHBLS-A_01_01_ENG Copyright European Resuscitation Council

4 Universal Algorithm Unresponsive? t breathing or only occasional gasps Call Resuscitation Team CPR 30:2 Attach defibrillator/monitor Assess rhythm Shockable (VF/Pulseless VT) n-shockable (PEA/Asystole) Return of 1 Shock spontaneous circulation Immediately resume: CPR for 2 min Immediate post cardiac arrest treatment Use ABCDE approach Controlled oxygenation and ventilation 12-lead ECG Treat precipitating cause Temperature control / therapeutic hypothermia Immediately resume: CPR for 2 min During CPR Ensure high-quality CPR: rate, depth, recoil Plan actions before interrupting CPR Give oxygen Consider advanced airway and capnography Continuous chest compressions when advanced airway in place Vascular access (intravenous, intraosseous) Give adrenaline every 3-5 min Correct reversible causes Reversible causes Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Thrombosis Tamponade - cardiac Toxins Tension pneumothorax Product reference: Poster_10_ALS_01_01_ENG Copyright European Resuscitation Council

5 Bradycardia Algorithm Assess using the ABCDE approach Ensure oxygen given and obtain IV access Monitor ECG, BP, SpO, record 12 lead ECG 2 Identify and treat reversible causes (e.g. electrolyte abnormalities) Assess for evidence of adverse signs: 1 Shock 2 Syncope 3 Myocardial ischaemia 4 Heart failure Atropine 500 mcg IV Satisfactory Response? Interim measures: Atropine 500 mcg IV repeat to maximum of 3 mg Isoprenaline 5 mcg min -1 Adrenaline 2-10 mcg min -1 Alternative drugs* OR Transcutaneous pacing Risk of asystole? Recent asystole Möbitz II AV block Complete heart block with broad QRS Ventricular pause > 3s Seek expert help Arrange transvenous pacing Observe * Alternatives include: Aminophylline Dopamine Glucagon (if beta-blocker or calcium channel blocker overdose) Glycopyrrolate can be used instead of atropine Product reference: Poster_10_ALS-BRAD_01_01_ENG Copyright European Resuscitation Council

6 Tachycardia Algorithm Assess using the ABCDE approach Ensure oxygen given and obtain IV access Monitor ECG, BP, SpO 2, record 12 lead ECG Identify and treat reversible causes (e.g. electrolyte abnormalities) Synchronised DC Shock* Up to 3 attempts Unstable Assess for evidence of adverse signs 1. Shock 2. Syncope 3. Myocardial ischaemia 4. Heart failure Stable Is QRS narrow (< 0.12 sec)? Amiodarone 300 mg IV over min and repeat shock; followed by: Amiodarone 900 mg over 24 h Broad Narrow Irregular Broad QRS Is QRS regular? Regular Regular Narrow QRS Is rhythm regular? Irregular Seek expert help Use vagal manoeuvres Adenosine 6 mg rapid IV bolus; if unsuccessful give 12 mg; if unsuccessful give further 12 mg. Monitor ECG continuously Irregular Narrow Complex Tachycardia Probable atrial fibrillation Control rate with: ß-Blocker or diltiazem Consider digoxin or amiodarone if evidence of heart failure Anticoagulate if duration > 48h Possibilities include: AF with bundle branch block treat as for narrow complex Pre-excited AF consider amiodarone Polymorphic VT (e.g. torsades de pointes - give magnesium 2 g over 10 min) *Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia If Ventricular Tachycardia (or uncertain rhythm): Amiodarone 300 mg IV over min; then 900 mg over 24 h If previously confirmed SVT with bundle branch block: Give adenosine as for regular narrow complex tachycardia rmal sinus rhythm restored? Probable re-entry PSVT: Record 12-lead ECG in sinus rhythm If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis Seek expert help Possible atrial flutter Control rate (e.g. ß-Blocker) Product reference: Poster_10_ALS-TACH_01_01_ENG Copyright European Resuscitation Council

7 Paediatric Basic Life support Health professionals with a duty to respond UNRESPONSIVE? Shout for help Open airway NOT BREATHING NORMALLY? 5 rescue breaths NO SIGNS OF LIFE? 15 chest compressions 2 rescue breaths 15 compressions After 1 minute of CPR call national emergency number (or 112) or cardiac arrest team Product reference: Poster_10_PaedBLS_01_01_ENG Copyright European Resuscitation Council

8 Paediatric Life Support Unresponsive? t breathing or only occasional gasps CPR (5 initial breaths then 15:2) Attach defibrillator/monitor Call Resuscitation Team (1 min CPR first, if alone) Assess rhythm Shockable (VF/Pulseless VT) n-shockable (PEA/Asystole) Return of 1 Shock 4 J/Kg spontaneous circulation Immediately resume: CPR for 2 min Immediate post cardiac arrest treatment Use ABCDE approach Controlled oxygenation and ventilation Investigations Treat precipitating cause Temperature control Therapeutic hypothermia? Immediately resume: CPR for 2 min During CPR Ensure high-quality CPR: rate, depth, recoil Plan actions before interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenaline every 3-5 min Consider advanced airway and capnography Continuous chest compressions when advanced airway in place Correct reversible causes Reversible causes Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Tension pneumothorax Toxins Tamponade - cardiac Thromboembolism Product reference: Poster_10_PALS_01_01_ENG Copyright European Resuscitation Council

9 Newborn Life Support At all stages ask: Do you need HELP? Dry the baby Remove any wet towels and cover Start the clock or note the time Assess (tone), breathing and heart rate If gasping or not breathing Open the airway Give 5 inflation breaths Consider SpO 2 monitoring Re-assess If no increase in heart rate Look for chest movement If chest not moving Recheck head position Consider two-person airway control or other airway manoeuvres Repeat inflation breaths Consider SpO 2 monitoring Look for a response If no increase in heart rate Look for chest movement When the chest is moving If the heart rate is not detectable or slow (< 60) Start chest compressions 3 compressions to each breath Reassess heart rate every 30 seconds If the heart rate is not detectable or slow (< 60) Consider venous access and drugs Birth 30 sec 60 sec Acceptable pre-ductal SpO 2 2 min: 60% 3 min: 70% 4 min: 80% 5 min: 85% 10 min: 90% Product reference: Poster_10_NLS_01_01_ENG Copyright European Resuscitation Council

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