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Adult Basic Life Support

UNRESPONSIVE?

Shout for help

Open airway

NOT BREATHING NORMALLY?

Call 112*

30 chest compressions

2 rescue breaths 30 compressions *or national emergency number


Fig 1.2_Adult BLS Final

Automated External Debrillator Algorithm


unresponsive?

Call for help

Open airway Not breathing normally Send or go for AED Call 112* * or national emergency number

until AED is attached

CPR 30:2

AED assesses rhythm

Shock advised 1 Shock


Immediately resume: CPR 30:2 for 2 min

No shock advised

Immediately resume: CPR 30:2 for 2 min

Continue until the victim starts to wake up: to move, opens eyes and to breathe normally
Fig 1.4_BLS-AED Final

Adult Foreign Body Airway Obstruction Treatment


Assess severity

Severe airway obstruction (ineffective cough)

Mild airway obstruction (effective cough)

Unconscious Start CPR

Conscious 5 back blows 5 abdominal thrusts

Encourage cough Continue to check for deterioration to ineffective cough or until obstruction relieved

Fig 1.3_Adult FBAO Final

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

with oxygen and airway adjuncts

CPR 30:2

Apply pads/monitor Attempt defibrillation if appropriate

Call resuscitation team If appropriate

Advanced Life Support


when resuscitation team arrives
Fig 1.5_InHospital Resuscitation Final

Handover to resuscitation team

Advanced Life Support


unresponsive? Not breathing or only occasional gasps Call Resuscitation Team CPR 30:2 Attach debrillator/monitor Minimise interruptions

Assess rhythm

Shockable (VF/Pulseless VT)

Non-shockable (PEA/Asystole)

1 Shock

Return of spontaneous circulation

Immediately resume: CPR for 2 min Minimise interruptions

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 Minimise interruptions

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

Fig 1.6_Adult ALS Final

Tachycardia Algorithm (with pulse)


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)

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 10-20 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 brillation Control rate with: -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)

If Ventricular Tachycardia (or uncertain rhythm): Amiodarone 300 mg IV over 20-60 min; then 900 mg over 24 h If previously confirmed SVT with bundle branch block: Give adenosine as for regular narrow complex tachycardia

Normal sinus rhythm restored?

No

Seek expert help

Yes

*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia

Probable re-entry PSVT: Record 12-lead ECG in sinus rhythm If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis

Possible atrial utter Control rate (e.g. -Blocker)

Fig 1.7_Tachycardia Final

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)

Yes

Assess for evidence of adverse signs: 1 Shock 2 Syncope 3 Myocardial ischaemia 4 Heart failure

No

Atropine 500 mcg IV

Satisfactory Response? No

Yes

Yes

Risk of asystole? Recent asystole Mbitz II AV block Complete heart block with broad QRS Ventricular pause > 3s

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

No

Seek expert help Arrange transvenous pacing * Alternatives include: Aminophylline Dopamine Glucagon (if beta-blocker or calcium channel blocker overdose) Glycopyrrolate can be used instead of atropine
Fig 1.8_Bradycardia Final

Observe

Patient with clinical signs and symptoms of ACS 12 lead ECG


ST elevation

0.1 mV in 2 adjacent limb leads and/ or 0.2 mV in adjacent chest leads or (presumably) new LBBB

Other ECG alterations


(or normal ECG)

= NSTEMI if troponins (T or I) positive STEMI

= UAP if troponins remain negative

High risk dynamic ECG changes ST depression haemodynamic/rhythm instability diabetes mellitus
Fig 1.9_ACS Definitons Final

non-STEMI-ACS

ECG
Pain relief Nitroglycerin sl if systolic BP > 90 mmHg Morphine (repeated doses) of 3-5 mg until pain free

Antiplatelet treatment

160-325mg Acetylsalicylic acid chewed tablet (or iv) 75 600 mg Clopidogrel according to strategy*

STEMI

Non-STEMI-ACS

Thrombolysis preferred if no contraindications and inappropriate delay to PCI Adjunctive therapy: UFH, enoxaparin or fondaparinux

PCI preferred if timely available in a high volume center contraindications for fibrinolysis cardiogenic shock (or severe left ventricular failure) Adjunctive therapy: UFH, enoxaparin or bivalirudin may be considered

Early invasive strategy# UFH Enoxaparin or bivalirudin may be considered

Conservative or delayed invasive strategy# UFH (fondaparinux or bivalirudin may be considered in pts with high bleeding risk)

# According to risk stratification

Fig 1.10_ACS Treatment Final

Paediatric basic life support


UNRESPONSIVE? Shout for help

Open airway

NOT BREATHING NORMALLY?

5 rescue breaths

NO SIGNS OF LIFE?

30 chest compressions

2 rescue breaths 30 compressions After 1 minute of CPR call 112 or national emergency number
Fig 1.11_Paed BLS Final

Paediatric Foreign Body Airway Obstruction Treatment


Assess severity

Ineffective cough

Effective cough

Unconscious Open airway 5 breaths Start CPR

Conscious 5 back blows 5 thrusts


(chest for infant) (abdominal for child > 1 year)

Encourage cough Continue to check for deterioration to ineffective cough or until obstruction relieved

Fig 1.12_Paed FBAO Final

Paediatric Advanced Life Support


unresponsive? Not breathing or only occasional gasps

CPR (5 initial breaths then 15:2) Attach debrillator/monitor Minimise interruptions

Call Resuscitation Team


(1 min CPR rst, if alone)

Assess rhythm

Shockable (VF/Pulseless VT)

Non-shockable (PEA/Asystole)

1 Shock 4 J/kg

Return of spontaneous circulation

Immediately resume: CPR for 2 min Minimise interruptions

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 Minimise interruptions

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

Fig 1.13 Paed ALS Final

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

Birth

Assess (tone), breathing and heart rate

30 sec

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

Recheck head position Consider two-person airway control or other airway manoeuvres Repeat inflation breaths
Consider SpO2 monitoring Look for a response

Acceptable* pre-ductal SpO2 2 min : 60% 3 min : 70% 4 min : 80% 5 min : 85% 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.pediatrics.org/cgi/doi/10.1542/peds.2009-1510 Fig 1.14 NLS Algorithm Final

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