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Advanced Cardiac Resuscitation Guidelines

Advanced Cardiac Resuscitation Guidelines . By Muhammad Bayat. BLS- HAZARDS. Hazards- Make sure the scene is safe for you to help. Make sure you have universal precautions: gloves, Face Mask, and Apron. BLS- HELLO + HELP.

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Advanced Cardiac Resuscitation Guidelines

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  1. Advanced Cardiac Resuscitation Guidelines By Muhammad Bayat

  2. BLS- HAZARDS • Hazards- Make sure the scene is safe for you to help. Make sure you have universal precautions: gloves, Face Mask, and Apron

  3. BLS- HELLO + HELP • Determine if the patient is conscious by tapping and shouting "Are you OK?" If no response have someone call for the crash cart

  4. BLS- Airway • Position the patient on their back. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver. • Suction the airway and clear out any foreign bodies • Insert an appropriate sized Guedel airway

  5. BLS - Breathing • LOOK-LISTEN-&-FEELING for breaths • CHECK REATHING FOR 5-10 SECONDS. • If they isn’t breathing VENTILATE TWICE -Rescue Breathing

  6. BLS- Circulation Check • Check for a pulse by palpating(feeling) the carotid artery. CHECK THE PULSE FOR 10 SECONDS.

  7. BLS- Circulation • If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS for both one and two man CPR

  8. BLS - CPR • Recheck the pulse after ONE MINUTE. CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE. Approximately 4 cycles will pass before the pulse check

  9. Advanced Life Support • Recommended Minimum Equipment for the Management of Adult Cardiopulmonary Arrest AIRWAY EQUIPMENT • Self inflating resuscitation bag with oxygen reservoir and tubing -BVM • Laryngoscopes x 2 - normal and long blades • Spare laryngoscope bulbs and batteries

  10. ALS AIRWAY EQUIPMENT • 1" ribbon gauze/tape • Scissors • Syringe - 20 mls • Oxygen cylinders x 2 (if no wall oxygen) • KY Jelly

  11. ALS - Equipment CIRCULATION EQUIPMENT • Intravenous cannulae 18 gauge x 3, 14 gauge x 3 • Hypodermic needles 21 gauge x 10 • Syringes 2 mls x 6, 5 mls x 6, 10 mls x 6, 20 mls x 6 • Intravenous giving sets • IV Infusion Fluid- MRL

  12. Basic ALS Drugs • DRUGS • Adrenaline / Epinephrine 1 mg (1:1000) • Atropine 3 mgs • Amiodarone 300mgs • Phenergan • Hydrocortisone • Lignocaine

  13. ALS - Additional Equipment ADDITIONAL ITEMS • ECG Electrodes • Defibrillation Gel pads • Pulse Oximeter • Gloves/Goggles/Aprons • NIBP Monitor

  14. ALS- Management Heart rhythms associated with cardiac arrest can be divided into two groups: 1.) ventricular fibrillation / pulseless ventricular tachycardia (VF/VT) 2.)Other rhythms. Asystole and pulseless electrical activity (PEA).

  15. ALS -Rhythm Why the Differentiation? • The management of these two groups of arrhythmias is different • Defibrillation in those patients with VF/VT • Drugs used in the other rhythms

  16. ALS- Rhythm Recognition Similarities • CPR , Airway management and Ventilation, venous access, the administration of epinephrine (adrenaline) and the identification and correction of contributing factors, are common to both groups.

  17. ECG RHYTHMN REGONITION • Ventricular Fibrillation • Asystole

  18. ALS- Defibrillation • Turn on the Machine • Change Lead Select • Gel the Paddles • Confirm the Rhythm • Set Energy level at • 200J • 3 stacked defibrillation of 200,200,360J

  19. ALS- Advanced Airway • Prepare Equipment • Insert Airway • Check Position • Ventilate • Consider Surgical Airway -Cricothyroidotomy

  20. ALS- Drug Therapy VENTRICULAR FIBRILLATION Adrenaline • Dilute 1mg of 1:1000 adrenaline into 10mls • Give 1mg every 3minutes followed by a stacked shock after 1 minute of CPR • Maximum dose = 3mg

  21. ALS- Drug Therapy Atropine • Used in Asystole and PEA • Mech.. Of Action : Vagolytic Drug • Given at a dose of 1mg every 3 minutes till a maximum of 3mg

  22. ALS- Drug Therapy Amiodarione • Used in persistent VF that remains despite adrenaline • Used post 2nd defibrillation attempt • 300mgf bolus given mixed with 20ml of dextrose

  23. Anaphylaxis Clinical Features • Urticaria (hives) and/or angioedema • Hypotension -Shock • Upper Resp Tract Obstruction. • Bronchospasm • Cyanosis

  24. Anaphylaxis-Treatment • Prevention • ALS- Airway Protection,Breathing, Circulation • Adrenaline (0.5ml IMI & Nebulised & IV) • Antihistamines (Promethazine 25mg) • Adrenergic Agonists (Salbutamol Nebs) • Hydrocortisone (200mg IVI)

  25. ALS- Take Home Message • Do Not Panic • Remember ABC’s • Defibrillate only a VF/VT & remember the GEL • Adrenaline is common drug to all the protocols

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