european

resuscitation
council

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

If breathing normally
or not breathing
Call 112, find & bring an AED
Start CPR immediately *
Turn into recovery position
Place your hands in the centre of the chest • Call 112
Deliver 30 chest compressions: • Continue to assess that breathing
remains normal
• Press firmly at least 5 cm deep
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

Nobody 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*.

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Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_BLSAED_01_01_ENG Copyright European Resuscitation Council
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In-hospital Resuscitation

Collapsed/sick patient

Shout for HELP

& assess patient

If NO signs of life If signs of life

Call resuscitation team

Assess ABCDE
Recognise & treat
CPR 30:2 Oxygen, monitoring, iv access

with oxygen and airway adjuncts

Call resuscitation team

If appropriate

Apply pads/monitor Handover to

resuscitation team
Attempt defibrillation
if appropriate

Advanced Life Support

when resuscitation team arrives

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_IHBLS_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
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In-hospital Resuscitation

Collapsed/sick patient

Shout for HELP & assess patient

No Signs of life? Yes

Call resuscitation team

Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access

CPR 30:2
with oxygen and airway adjuncts

Call resuscitation team

Apply pads/monitor If appropriate
Attempt defibrillation if appropriate

Advanced Life Support

Handover to resuscitation team
when resuscitation team arrives

www.erc.edu | info@erc.edu | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_IHBLS-A_01_01_ENG Copyright European Resuscitation Council
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Advanced Life Support

Universal Algorithm

Unresponsive?
Not breathing or only occasional gasps

Call
Resuscitation Team

CPR 30:2
Attach defibrillator/monitor
Minimise interruptions

Assess
rhythm

Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)

Return of
1 Shock spontaneous
circulation

Immediately resume: Immediate post cardiac Immediately resume:

arrest treatment
CPR for 2 min CPR for 2 min
• Use ABCDE approach
Minimise interruptions • Controlled oxygenation and Minimise interruptions
ventilation
• 12-lead ECG
• Treat precipitating cause
• Temperature control /
therapeutic hypothermia

During CPR Reversible causes

• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Consider advanced airway and capnography • Hypothermia
• Continuous chest compressions when advanced airway in place
• Thrombosis
• Vascular access (intravenous, intraosseous)
• Tamponade - cardiac
• Give adrenaline every 3-5 min
• Toxins
• Correct reversible causes
• Tension pneumothorax

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_ALS_01_01_ENG Copyright European Resuscitation Council
european
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Advanced Life Support

Bradycardia Algorithm

• Assess using the ABCDE approach

• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2, record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)

Assess for evidence of adverse signs:

1 Shock
Yes 2 Syncope No
3 Myocardial ischaemia
4 Heart failure

Atropine
500 mcg IV

Satisfactory
Yes
Response?

No Risk of asystole?
• Recent asystole
Yes • Möbitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s
Interim measures:
• Atropine 500 mcg IV
repeat to maximum of 3 mg
No
• Isoprenaline 5 mcg min-1
• Adrenaline 2-10 mcg min-1
• Alternative drugs*
OR
• Transcutaneous pacing

Seek expert help Observe

Arrange transvenous pacing

* Alternatives include:
• Aminophylline
• Dopamine
• Glucagon (if beta-blocker or calcium channel
blocker overdose)
• Glycopyrrolate can be used instead of atropine

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_ALS-BRAD_01_01_ENG Copyright European Resuscitation Council
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Advanced Life Support

Tachycardia Algorithm
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 , record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)

Assess for evidence of adverse signs

Synchronised DC Shock* Unstable 1. Shock 2. Syncope Stable Is QRS narrow (< 0.12 sec)?
Up to 3 attempts
3. Myocardial ischaemia 4. Heart failure

• Amiodarone 300 mg IV over

10-20 min and repeat shock; Broad Narrow
followed by:
• Amiodarone 900 mg over 24 h

Broad QRS Narrow QRS

Irregular Regular Regular Irregular
Is QRS regular? Is rhythm regular?

Seek expert help • Use vagal manoeuvres Irregular Narrow Complex

• Adenosine 6 mg rapid IV bolus;
if unsuccessful give 12 mg;
if unsuccessful give further 12 mg.
• Monitor ECG continuously
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: If Ventricular Tachycardia Normal sinus rhythm restored? No Seek expert help
• AF with bundle branch block (or uncertain rhythm):
treat as for narrow complex • Amiodarone 300 mg IV over
• Pre-excited AF 20-60 min; then 900 mg over 24 h
Yes
consider amiodarone
• Polymorphic VT If previously confirmed
(e.g. torsades de pointes - SVT with bundle branch block:
give magnesium 2 g over 10 min) • Give adenosine as for regular
narrow complex tachycardia
Probable re-entry PSVT: Possible atrial flutter
• Record 12-lead ECG in sinus rhythm • Control rate (e.g. ß-Blocker)
• If recurs, give adenosine again &
consider choice of anti-arrhythmic
*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia prophylaxis

www.erc.edu | info@erc.edu | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_ALS-TACH_01_01_ENG Copyright European Resuscitation Council
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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

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_PaedBLS_01_01_ENG Copyright European Resuscitation Council
european
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Paediatric Life Support

Advanced Life Support

Unresponsive?
Not breathing or only occasional gasps

CPR (5 initial breaths then 15:2) Call Resuscitation

Attach defibrillator/monitor Team
Minimise interruptions (1 min CPR first, if alone)

Assess
rhythm

Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)

Return of
1 Shock 4 J/Kg spontaneous
circulation

Immediately resume: Immediate post cardiac Immediately resume:

arrest treatment
CPR for 2 min CPR for 2 min
• Use ABCDE approach
Minimise interruptions • Controlled oxygenation and Minimise interruptions
ventilation
• Investigations
• Treat precipitating cause
• Temperature control
• Therapeutic hypothermia?

During CPR Reversible causes

• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Vascular access (intravenous, intraosseous) • Hypothermia
• Give adrenaline every 3-5 min
• Tension pneumothorax
• Consider advanced airway and capnography
• Toxins
• Continuous chest compressions when advanced airway in place
• Tamponade - cardiac
• Correct reversible causes
• Thromboembolism

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_PALS_01_01_ENG Copyright European Resuscitation Council
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At all stages ask: Do you need HELP? Newborn Life Support

Dry the baby Birth

Remove any wet towels and cover
Start the clock or note the time

Assess (tone), 30 sec

breathing and heart rate

If gasping or not breathing

Open the airway
Give 5 inflation breaths
Consider SpO2 monitoring 60 sec

Re-assess
If no increase in heart rate
Look for chest movement

If chest not moving Acceptable

pre-ductal SpO2
Recheck head position
2 min: 60%
Consider two-person airway control
3 min: 70%
or other airway manoeuvres
4 min: 80%
Repeat inflation breaths
Consider SpO2 monitoring 5 min: 85%
Look for a response 10 min: 90%

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

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_NLS_01_01_ENG Copyright European Resuscitation Council