put italltogether06122011
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ALS Subcommittee 2010
PUT IT ALL TOGETHER
ALS Subcommittee 2010
ALS Subcommittee 2010
Collapsed patient
With cardiac output
• Tachyarrhythmias
• Bradyarrhythmias
Without cardiac output
Shock-able rhythm
• Ventricular fibrillation
• Pulseless VT
Non shock-able rhythm
• Asystole
• Pulseless electrical activity
ALS Subcommittee 2010 ALS Subcommittee 2010
VF / Pulseless VT
•Avoid Danger
•Check Responsiveness
•Shout: Activate emergency response system
Call for defibrillator and resus trolley
• A Airway: open the airway
• B Breathing: assess if no breathing or agonal breathing
• C Circulation: give chest compressions
• D Defibrillation: assess rhythm and shock VF/pulseless
VT (360J monophasic or 120-200J biphasic)
ALS Subcommittee 2010 ALS Subcommittee 2010
VF / Pulseless VT …. cont
•Adrenaline 1 mg IV push, repeat every 3 to 5 minutes OR Vasopressin 40 U IV, single dose, 1 time only
Resume attempts to defibrillate 1 x 360 J (or equivalent biphasic)
Consider antiarrhythmics: •Amiodarone 300mg bolus OR
•Lignocaine 1mg/kg bolus •Magnesium ( known hypomagnesemic state)
Resume attempts to defibrillate
Chest compression
continues with
minimal interruptions
Resume attempts to defibrillate 1 x 360 J (or equivalent biphasic)
ALS Subcommittee 2010 ALS Subcommittee 2010
Asystole / PEA
•Avoid Danger
•Check Responsiveness
•Shout: Activate emergency response system
Call for defibrillator and resus trolley
• A Airway: open the airway
• B Breathing: assess if no breathing or agonal breathing
• C Circulation: give chest compressions
• D Defibrillation: non-shockable rhythm
ALS Subcommittee 2010 ALS Subcommittee 2010
Asystole/ PEA ….cont
• Adrenaline 1 mg IV push - repeat every 3 to 5 minutes - vasopression 40U may replace 1 dose of adrenaline
• CPR
• Drugs
• Determine causes of PEA or Asystole
- consider 6 Hs and 5 Ts
ALS Subcommittee 2010 ALS Subcommittee 2010
Asystole/ PEA ….cont
• Consider quality of resuscitation?
• Atypical clinical features present?
• Consider ceasing resuscitation
• Search for DNR order
ALS Subcommittee 2010 ALS Subcommittee 2010
Patient with pulse
• Reassurance
• Oxygen
• IV access
• Monitor
ALS Subcommittee 2010
ALS Subcommittee 2010
Tachyarrhythmias
Stable
• Medications
• ± maneuvers
Unstable
• Cardioversion
• Consider amiodarone after 3x cardioversion
ALS Subcommittee 2010 ALS Subcommittee 2010
Bradyarrhythmias
• Symptomatic : medications ± pacing
ALS Subcommittee 2010 ALS Subcommittee 2010
Success Of CPR
• Team effort:
– good team members
– good team leader
– knowledge
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ALS Subcommittee 2010 ALS Subcommittee 2010
THANK YOU NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
Dr Tan Cheng Cheng
Dr Luah Lean Wah
Dr Ismail Tan
Dr Wan Nasrudin
Dr Chong Yoon Sin
Dr Priya Gill
Dr Ridzuan bin Dato’ Mohd Isa
Dr Thohiroh Abdul Razak
Dr Adi Osman
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