The Resuscitation Guidelines 2005

1. The Resuscitation Guidelines 2005 The slides here are modified from the 2005 Resuscitation Council (UK) Guidelines for the Management of Adult Cardiac Arrest. They have been prepared for the University of Dundee Medical Students.

3. …. to confirm cardiac arrest Open Airway Look for signs of life • Patient response • Open airway • Check for normal breathing • caution agonal breathing • Check for signs of life

4. …. to confirm cardiac arrest Open Airway Look for signs of life • Pulse check if trained to do so • Take no more than 10 seconds for assessment of both breathing and pulse.

5. Cardiac arrest confirmed Call Ambulance or Resuscitation Team Check 123, ABC CPR 30:2 Until defibrillator / monitor attached

6. Chest compression • 30:2 • Compressions • “Centre of chest” • 4-5 cm depth • 100 min-1 • Uninterrupted compressions when airway secured • Avoid • Provider fatigue • Interruptions

7. Open Airway Look for signs of life ALS Algorithm Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached Assess Rhythm

8. How to assess ECG rhythm? • ECG monitoring leads • Self-adhesive electrodes • ‘Quick-look’ paddles

9. ECG monitoring leads • 3-lead system approximates to I, II, III • Colour coded • Remove hair • Apply over bone • Lead setting (II)

10. Self-adhesive electrodes • Hands-free • Remove excess chest hair • Dry chest if necessary • Continue CPR whilst applying

11. ‘Quick-look’ paddles • Hold still • Apply firm pressure • Use coupling agent – gel pads

12. If using an automated external defibrillator (AED) • When AED arrives switch on • Follow voice and visual prompts • Perform other skills according to your training e.g. pocket mask ventilation, IV access, drugs

13. Shockable Rhythms (VF/Pulseless VT)

14. Open Airway Look for signs of life ALS Algorithm Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Non-shockable (PEA/Asystole) Shockable (VF/Pulseless VT)

15. Precordial thump • Rapid treatment of a witnessed and monitored VF/VT cardiac arrest • Use if defibrillator not immediately available

18. VF/Pulseless VT • Check pulse if • Organised rhythm seen after 2 min CPR • Patient showing signs of life • Adrenaline 1mg IV every 2 loops • Just before alternate shocks • Amiodarone given once only

19. Defibrillation energies • Vary with manufacturer • Check local equipment • If unsure, deliver 200 J (do not delay shock) • Energy levels for defibrillators in this hospital/university 360 J monophasic (150 Joules for biphasic models)

20. Non-shockable Rhythms PEA/Asystole

21. Open Airway Look for signs of life ALS Algorithm Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Non-shockable (PEA/Asystole) Shockable (VF/Pulseless VT)

23. PEA/Asystole • Check pulse if • A change to an organised rhythm seen after 2 min CPR • Patient showing signs of life • Adrenaline 1mg IV every 2 loops as soon as IV access is achieved • In asystole and PEA (heart rate <60) Atropine 3mg is given once only

25. Airway and ventilation • Secure airway: • tracheal tube • LMA • Once airway secured, if possible, do not interrupt chest compressions for ventilation • Avoid hyperventilation

27. Any Questions regarding cardiopulmonary resuscitation can be referred to Susan Somerville, Resuscitation Officer, University of Dundee, via email: • s.g.somerville@dundee.ac.uk