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ALS

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ALS

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  1. ALS

  2. Objectives • Prevention of cardiac arrest • Revision of BLS • ALS algorithms - shockable ryhthms - non-shockable rhythms • Potential reversible causes of cardiac arrest • Safe debrillation (Zoll and AED) • Practice ALS scenarios

  3. Early recognition of the critically ill patient • Most arrests are predictable • Deterioration prior to 50 - 80% of cardiac arrests • Hypoxia and hypotension are common antecedents • Delays in referral to higher levels of care

  4. Call for help early!!!!! Early recognition prevents: • Cardiac arrests and deaths • Admissions to ICU, inappropriate resuscitations

  5. Confirm cardiorespiratory arrest • Check for danger • Check for response - if unresponsive • Call for help/met call – 666 at Liverpool • Open airway • Check for normal breathing • Start CPR – 30 chest compressions, then 2 breaths (30:2) • Attach AED/defib

  6. Basic Life Support • Compressions • lower ½ sternum • >/= 5 cm depth (1/3 depth chest) • 100 min-1 • Ratio 30:2 breaths until airway secured • Avoid! • Interruptions (<10 seconds) • Provider fatigue (swap every cycle)

  7. Airway and ventilation • Oxygenation important NOT intubation • No evidence that intubation improves outcome (& may interrupt compressions) • Open airway, place Guedel then Bag-Valve mask ventilation is ok initially • Met team may consider advanced airway: LMA (or ETT) • Avoid hyperventilation (6-10/min max)

  8. Rhythm ? – Shockable or Non-Shockable

  9. Shockable • Ventricular Fibrillation: • Bizarre irregular waveform • No recognisable QRS complexes • Random frequency and amplitude • Uncoordinated electrical activity

  10. Rhythm ? – Shockable or Non-Shockable

  11. Shockable • VT (monomorphic) • broad complex regular rhythm • rapid rate • constant QRS morphology

  12. Defibrillation • Must be safe – live current!! –all hands off patient, 02 away • Energy varies with manufacturer - Check local equipment • Biphasic (Zoll) give 200 J standard (can alter energy level manually) • AED – automatic – set at 200J • Must do 2 mins CPR after any shock before checking rhythm

  13. Rhythm ? – Shockable or Non-Shockable

  14. Non-shockable • Asystole: • Absent ventricular (QRS) activity • Atrial activity (P waves) may persist • Rarely a straight line trace

  15. Non-shockable • Pulseless electrical activity: • Clinical features of cardiac arrest • ECG normally associated with an output

  16. CORRECT REVERSIBLE CAUSES • Hypoxaemia • Hypovolaemia • Hypo/hyperthermia • Hypo/hyperkalaemia & other metabolic disorders • Tamponade • Tension pneumothorax • Toxins / Poisons / Drugs • Thrombus - pulmonary / coronary

  17. Adrenaline Dose: 1mg IV • VF/VT – give after 2nd shock • Non VF/VT – give immediately • Repeat every 3-5 min ie alternate cycles

  18. Anyquestions

  19. Summary • ALS algorithm provides a standardised approach to the treatment of cardiac arrest in adults • Shockable rhythms (VF/pulseless VT) • Non-shockable rhythms • Reversible causes of cardiac arrest • Common drugs used