Makindo Medical Notes.com

Related Subjects: |Adrenaline/Epinephrine |Atropine |Adult Resus:Acute Anaphylaxis |Adult Resus:Basic Life Support |Adult Resus: Advanced Life Support |Adult Resus: Obstetric Cardiac Arrest |Newborn/Child Resus: All |Acute Hypotension |Cardiogenic shock |Distributive Shock |Hypovolaemic or Haemorrhagic Shock |Obstructive Shock |Septic Shock and Sepsis |Shock (General Assessment) |Toxic Shock Syndrome |Resus:Bradycardia |Resus:Tachycardia |Resus:Hyperkalaemia |Resus:Post Resuscitation Algorithm |Resus:Acute Severe Asthma |Resus:Acute Haemorrhage

Resuscitation - Advanced Life Support

During CPR

• Ensure high quality CPR (rate, depth, recoil)
• Plan actions before interrupting CPR
• Give oxygen; Consider advanced airway & capnography;
• Continuous chest compressions when advanced airway in place
• Vascular access - iv or intraosseous; ? Give Adrenaline every 3-5mins; ? Correct irreversible causes
• Arrhythmias associated with cardiac arrest are divided into

Causes: see resuscitation

• Ventricular fibrillation (shockable)
• Pulseless ventricular tachycardia (shockable)
• Asystole (not shockable)
• Pulseless electrical activity. (not shockable)

Resuscitation - Advanced Life Support + COVID

Shockable (VF/VT)

• Need for defibrillation in VF/VT. VF/VT is the first monitored rhythm in 25% of all cardiac arrests and in 25% at some stage during resuscitation of cardiac arrests with the initial documented rhythm of asystole or PEA.
• Once VF/VT is confirmed: Resume chest compressions immediately. Simultaneously, the designated person should select the appropriate energy on the defibrillator (150-200J biphasic for the 1st shock and 150-360J biphasic for subsequent shocks.
• As the defibrillator is charged, warn all rescuers other than the individual doing chest compressions to "stand clear". Remove any oxygen delivery device as appropriate. Ensure rescuer giving compressions is the only person touching the patient.
• Once the defibrillator is charged, tell the rescuer performing chest compressions to "stand clear". When clear, give the shock.
• Without reassessing the rhythm or feeling for a pulse, restart CPR using a ratio of 30:2 starting with chest compressions. Continue CPR for 2 min. The team leader prepares the team for the next pause in CPR.
• Pause briefly to check the monitor: if VF/VT, repeat steps 1-5 above and deliver a 2nd shock. If VF/VT persists repeat steps 1-3 above and deliver a 3rd shock. Resume chest compressions immediately and then give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2 min CPR.
• Repeat 2 min CPR- rhythm/pulse check-defibrillation sequence if VF/VT persists. 7. Give further adrenaline 1 mg IV after alternate shocks (i.e. ~ every 3-5 min)

Non-shockable (asystole and PEA) rhythms.

• Non-shockable rhythms (PEA and asystole) Pulseless electrical activity (PEA) is defined as the absence of any palpable pulse in the presence of cardiac electrical activity expected to produce cardiac output.
• These patients often have some mechanical PEA that may be caused by reversible conditions that can be treated if identified and corrected.
• Survival following cardiac arrest with asystole or PEA is unlikely unless a reversible cause can be found and treated effectively.
• Sequence of actions for PEA
  • Start CPR 30:2. Give adrenaline 1 mg as soon IV access is achieved.
  • Continue CPR 30:2 until the airway is secured, then continue chest compressions without pausing during ventilation. Consider and correct reversible causes of PEA
  • Recheck the patient after 2 min: If there is still no pulse and no change in the ECG appearance:
  • Continue CPR; Recheck the patient after 2 min and proceed accordingly.
  • Give further adrenaline 1 mg every 3-5 min (alternate loops).
  • If VF/VT, change to the shockable rhythm algorithm. If a pulse is present, start post-resuscitation care.
• Sequence of actions for asystole
  • Start CPR 30:2. Without stopping CPR, check that the leads are attached correctly. Give adrenaline 1 mg as soon as IV access is achieved.
  • Continue CPR 30:2 until the airway is secured, then continue chest compression without pausing during ventilation.
  • Consider possible reversible causes of PEA and correct any that are identified.
  • Recheck the rhythm after 2 min and proceed accordingly.
  • If VF/VT, change to the shockable rhythm algorithm.
  • Give adrenaline 1 mg IV every 3-5 min (alternate loops).
  • Whenever a diagnosis of asystole is made, check the ECG carefully for P waves as the patient may respond to cardiac pacing when there is ventricular standstill with continuing P waves. There is no value in attempting pacing in true asystole.

  References

  • ALS Guidance