Advanced Life Support

Transcription

1 Aim for ormal PaCO 2 EUROPEAN Advaced Life Support Uresposive ad ot breathig ormally? Call Resuscitatio Team CPR 30:2 Attach defibrillator/moitor Miimise iterruptios Assess rhythm Shockable (VF/Pulseless VT) No-shockable (PEA/Asystole) 1 Shock Miimise iterruptios Retur of spotaeous circulatio Immediately resume CPR for 2 mi Miimise iterruptios IMMEDIATE POST CARDIAC ARREST TREATMENT Use ABCDE approach Aim for SaO of 94-98% 2 Immediately resume CPR for 2 mi Miimise iterruptios 12 Lead ECG Treat precipitatig cause Targeted temperature maagemet DURING CPR Esure high quality chest compressios Miimise iterruptios to compressios Give oxyge Use waveform capography Cotiuous compressios whe advaced airway i place Vascular access (itraveous or itraosseous) Give adrealie every 3-5 mi Give amiodaroe after 3 shocks TREAT REVERSIBLE CAUSES Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia/hyperthermia CONSIDER Thrombosis coroary or pulmoary Tesio peumothorax Tampoade cardiac Toxis Ultrasoud imagig Mechaical chest compressios to facilitate trasfer/treatmet Coroary agiography ad percutaeous coroary itervetio Extracorporeal CPR Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_ALS_Algorithm_ENG_

2 I-hospital Resuscitatio Collapsed / sick patiet Shout for HELP & assess patiet No Sigs of life? Yes Call resuscitatio team Assess ABCDE Recogise & treat Oxyge, moitorig, IV access CPR 30:2 with oxyge ad airway adjucts Call resuscitatio team if appropriate Apply pads/moitor Attempt defibrillatio if appropriate Advaced Life Support whe resuscitatio team arrives Hadover to resuscitatio team Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_ALS_IHCAT_Algorithm_ENG_

3 Newbor Life Support (Ateatal cousellig) Team briefig ad equipmet check Birth Dry the baby Maitai ormal temperature Start the clock or ote the time Assess (toe), breathig ad heart rate If gaspig or ot breathig: Ope the airway Give 5 iflatio breaths Cosider SpO 2 ± ECG moitorig Maitai Temperature Re-assess If o icrease i heart rate look for chest movemet If chest ot movig: Recheck head positio Cosider 2-perso airway cotrol ad other airway maoeuvres Repeat iflatio breaths SpO 2 moitorig ± ECG moitorig Look for a respose 60 s Acceptable pre-ductal SpO 2 2 mi 60 % 3 mi 70 % 4 mi 80 % 5 mi 85 % 10 mi 90 % At All Times Ask: Do You Need Help? If o icrease i heart rate look for chest movemet Whe the chest is movig: If heart rate is ot detectable or very slow (< 60 mi -1 ) Start chest compressios Coordiate compressios with PPV (3:1) Reassess heart rate every 30 secods If heart rate is ot detectable or very slow (< 60 mi -1 ) cosider veous access ad drugs Icrease oxyge (Guided by oximetry if available) Discuss with parets ad debrief team Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_NLS_Algorithm_ENG_

4 Basic Life Support ad Automated Exteral Defibrillatio (AED) Uresposive ad ot breathig ormally Call Emergecy Services Give 30 chest compressios Give 2 rescue breaths Cotiue CPR 30:2 As soo as AED arrives - switch it o ad follow istructios Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_BLS_Algorithm_ENG_

5 EUROPEAN Basic Life Support with the use of a Automated Exteral Defibrillator (AED) Check respose If uresposive If uresposive ad ot breathig ormally Shake getly Ask loudly: Are you all right? Ope airway & check for breathig Call 112, sed someoe to get a AED Start chest compressios immediately If breathig ormally Tur ito recovery positio Call 112 Cotiue to assess that breathig remais ormal As soo as AED arrives Switch o the AED & attach pads If shock is idicated Place your hads i the cetre of the chest Deliver 30 chest compressios: - Press firmly at least 5 cm but o more tha 6 cm deep - Press at a rate of at least 100/mi but o more tha 120/mi If traied ad able combie chest compressios with vetillatios otherwise cotiue with compressio oly CPR - Seal your lips aroud the mouth - Blow steadily util the chest rises - Give ext breath whe the chest falls Cotiue CPR 30 compressios to 2 vetilatios Follow the spoke/visual directios Attach oe pad below the left armpit Attach the other pad below the right collar boe, ext to the breastboe If more tha oe rescuer: do ot iterrupt CPR Stad clear ad deliver shock Cotiue CPR Follow AED istructios Cotiue CPR uless you are certai the victim has recovered ad starts to breathe ormally. Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_BLS_AutomatedExteralDefibrillator_Algorithm_ENG_

6 Paediatric Basic Life Support Uresposive? Shout for help Ope airway Not breathig ormally? 5 rescue breaths No sigs of life? 15 chest compressios 2 rescue breaths 15 compressios Call cardiac arrest team or Paediatric ALS team after 1 miute of CPR Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_PAEDS_BLS_ Algorithm_ENG_

7 Paediatric Advaced Life Support Uresposive? Not breathig or oly occasioal gasps CPR (5 iitial breaths the 15:2) Attach defibrillator/moitor Miimise iterruptios Call Resuscitatio Team (1 mi CPR first, if aloe) Assess rhythm Shockable (VF/Pulseless VT) No-shockable (PEA/Asystole) 1 Shock 4 J/Kg Retur of spotaeous circulatio Immediately resume: CPR for 2 mi Miimise iterruptios At 3 rd cycle ad 5 th cycle cosider amiodaroe i shock-resistat VF/pVT IMMEDIATE POST CARDIAC ARREST TREATMENT Use ABCDE approach Cotrolled oxygeatio ad vetilatio Ivestigatios Treat precipitatig cause Temperature cotrol Immediately resume: CPR for 2 mi Miimise iterruptios DURING CPR Esure high-quality CPR: rate, depth, recoil Pla actios before iterruptig CPR REVERSIBLE CAUSES Hypoxia Hypovolaemia Give oxyge Vascular access (itraveous, itraosseous) Give adrealie every 3-5 mi Cosider advaced airway ad capography Cotiuous chest compressios whe advaced airway i place Correct reversible causes Hyper/hypokalaemia, metabolic Hypothermia Thrombosis (coroary or pulmoary) Tesio peumothorax Tampoade (cardiac) Toxic/therapeutic disturbaces Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_PAEDS_PALS_ Algorithm_ENG_

8 Aaphylaxis Aaphylactic reactio? Assess usig ABCDE approach Diagosis - look for: Acute oset of illess Life-threateig Airway ad/or Breathig ad/or Circulatio problems 1 Ad usually ski chages Call for help Lie patiet flat with raised legs (if breathig allows) Adrealie 2 Whe skills ad equipmet available: Establish airway High flow oxyge IV fluid challege 3 Chlorpheamie 4 Moitor: Pulse oximetry ECG Blood pressure Hydrocortisoe 5 1. Life-threateig problems: Airway: swellig, hoarseess, stridor Breathig: rapid breathig, wheeze, fatigue, cyaosis, SpO 2 < 92%, cofusio Circulatio: pale, clammy, low blood pressure, faitess, drowsy/coma 2. Adrealie (give IM uless experieced with IV adrealie) IM doses of 1:1000 adrealie (repeat after 5 mi if o better) Adult 500 mcg IM (0.5 ml) Child more tha 12 years 500 mcg IM (0.5 ml) Child 6-12 years 300 mcg IM (0.3 ml) Child less tha 6 years 150 mcg IM (0.15 ml) Adrealie IV to be give oly by experieced specialists Titrate: Adults 50 mcg; Childre 1 mcg kg IV fluid challege (crystalloid): Adult ml Child 20 ml kg -1 Stop IV colloid if this might be the cause of aaphylaxis 4. Chlorpheamie 5. Hydrocortisoe (IM or slow IV) (IM or slow IV) Adult or child more tha 12 years 10 mg 200 mg Child 6-12 years 5 mg 100 mg Child 6 moths to 6 years 2.5 mg 50 mg Child less tha 6 moths 250 mcg kg mg Copyright: Europea Resuscitatio Coucil vzw - Reproduced with permissio from Elsevier Irelad Ltd.- licese umber Product referece: Poster_SpecCircs_Aaphylaxis_ENG_

9 Avalache Accidet Assess patiet at extricatio Lethal ijuries or whole body froze YES Do ot start CPR NO Duratio of burial (core temperature) 1 60 mi ( 30 C) Uiversal ALS algorithm 2 > 60 mi (< 30 C) Sigs of life? 3 YES Miimally ivasive rewarmig 4 NO Start CPR 5 Moitor ECG VF/pVT/PEA Asystole Patet airway YES or UNCERTAIN Cosider serum potassium 6 Hospital with ECLS NO > 8 mmol L -1 Cosider termiatio of CPR 1. Core temperature may substitute if duratio of burial is ukow 2. Trasport patiets with ijuries or potetial complicatios (e.g. pulmoary oedema) to the most appropriate hospital 3. Check for spotaeous breathig ad pulse for up to 1 mi 4. Trasport patiets with cardiovascular istability or core temperature < 28 C to a hospital with ECLS (extracorporeal life support) 5. Withold CPR if risk to the rescue team is uacceptably high 6. Crush ijuries ad depolarisig euromuscular blockig drugs may elevate serum potassium Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_SpecCircs_ AvalacheAccidet_Algorithm_ENG_

10 Drowig Uresposive ad ot breathig ormally? Shout for help ad call emergecy services Ope airway Give 5 rescue breaths / vetilatios supplemeted with oxyge if possible Sigs of life? Start CPR 30:2 Attach AED ad follow istructios Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_SpecCircs_ Drowig_Algorithm_ENG_

11 Hyperkalaemia Assess usig ABCDE approach 12-lead ECG ad moitor cardiac rhythm if serum potassium (K + ) 6.5 mmol L -1 Exclude pseudohyperkalaemia Give empirical treatmet for arrhythmia if hyperkalaemia suspected MILD K mmol L -1 Cosider cause ad eed for treatmet MODERATE K mmol L -1 Treatmet guided by cliical sceario, ECG ad rate of rise SEVERE K mmol L -1 Emergecy treatmet idicated Seek expert help Peaked T waves ECG chages? Broad QRS Bradycardia Flat / abset P waves Sie wave VT Protect the heart IV calcium 10 ml 10 % calcium chloride IV OR 30 ml 10 % calcium glucoate IV Use large IV access ad give over 5-10 mi Repeat ECG Cosider further dose after 5 mi if ECG chages persist Isuli glucose IV ifusio Glucose (25 g) with 10 uits soluble isuli over 15 mi IV 25 g glucose = 50 ml 50 % glucose OR 125 ml 20 % glucose Shift K + ito Risk of hypoglycaemia cells Salbutamol mg ebulised Remove K + from body Cosider calcium resoium 15 g x 4/day oral or 30 g x 2/day per rectum Cosider dialysis Seek expert help Moitor K + ad blood glucose Moitor serum potassium ad blood glucose K mmol L -1 despite medical therapy Prevetio Cosider cause of hyperkalaemia ad prevet recurrece Copyright: Europea Resuscitatio Coucil vzw - Reproduced with permissio from Real Associatio ad Resuscitatio Coucil (UK) Product referece: Poster_SpecCircs_Hyperkalaemia_Algorithm_ENG_

12 Traumatic Cardiac Arrest Trauma patiet Cardiac arrest / Periarrest situatio? Cosider o-traumatic cause LIKELY Uiversal ALS algorithm Hypoxia UNLIKELY Tesio peumothorax Tampoade Hypovolaemia Simultaeously address reversible causes 1. Cotrol catastrophic haemorrhage 2. Cotrol airway ad maximise oxygeatio 3. Bilateral chest decompressio Cotiue ALS Start / Elapsed time < 10 mi sice 4. Relieve cardiac tampoade 5. Surgery for haemorrhage cotrol or proximal aortic compressio? arrest? Expertise? 6. Massive trasfusio protocol ad fluids Equipmet? Eviromet? Cosider termiatio of CPR NO Retur of spotaeous circulatio? Cosider immediate resuscitative thoracotomy YES Pre-hospital: Perform oly life-savig itervetios Immediate trasport to appropriate hospital I-hospital: Damage cotrol resuscitatio Defiitive haemorrhage cotrol Copyright: Europea Resuscitatio Coucil vzw Product referece: Poster_SpecCircs_TraumaticCardiacArrest_Algorithm_ENG_