ADVANCE LIFE SUPPORT (RESUSCITATION COUNCIL (UK) 2000) | Tutorial D-1 CVS

130110110177|Gabriella Chafrina| 04/10/13

Airway Ventilation and protection
During these cycles of CPR:
Adequate ventilation must be established
The airway must be protected by an operator optimal way by insertion of a cuffed endotracheal tube
Endotracheal tube is for minimize the risk of aspiration of the gastric contents and allows effective ventilation
to be carried out
Endotracheal intubation can be hazardous procedure and a laryngeal mask airway is an alternative
Intravenous access must also be established either via a large peripheral vein or preferably via a central vein
Placing the defibrillator paddles
Placement is important because only a small proportions of the reaches the myocardium during transthoracic
defibrillation and every effort should be made to maximize:
The right paddle should be placed below the clavicle in the mid-clavicular line
The left paddle should be placed on the lower rib cage on the anterior axillary line
The VT/VF arm of the ALS algorithm
The 3 initial shocks are usually 200, 200, and 360 J. Subsequent shock are usually all 360 J.
After each shock the monitor should watched:
If the rhythm remains VF/VT CPR and defibrillation sequence should continue
If the arrhythmia persists antiarrhythmics can be used. IV amiodarone/bretylium
can be used, as can other agents
If the monitor shows a flat line after defibrillation doesnt necessarily mean asystole has
occurred. It is not uncommon for a period of myocardial stunning to occur after defibrillation
If the flat line persist CPR should be carried out for 1 min before adrenaline is given
(to allow period of stunning to pass)
The non-VT/VF arm of the ALS algorithm
This arm include asystole, electromechanical dissociation, and profound bradyarrhythmias.
Prognosis for patients in this arm is much poorer than in the VF/VT arm. Defibrillation is not required unless VT/VF
supervenes and 3-min cycles of CPR are given. During the 3 min, possible underlying causes must be excluded/treated:
Asystole is treated initially with IV atropine at a maximum total dose 3 mg and IV adrenaline 1 mg.
During subsequent cycles of CPR adrenaline may be repeated, but not the atropine
Bradyarrhythmias are treated initially with atropine in the same way. Patients who have bradyarrhythmia may
benefit from insertion of a temporary pacing wave
Electromechanical dissociation (EMD) occurs when there is regular rhythm on the monitor (not VT), but no cardiac
output arising from it. Underlying causes must be spught because these may be easily treated. Possible causes of EMD:
Hypovolaemia rapid administration of IV fluid required
Electrolyte imbalance (e.g. hypokalaemia, hypocalcaemia)
Tension pneumothorax suspect in trauma cases/after insertion of central line, look for absence of chest movement and breath sounds on 1 side, treat with cannula into the
pleural space at the 2
nd
intercostals space in mid-clavicular line followed by insertion of chest drain
Cardiac tamponade suspect in trauma cases and post-thoracotomy patients, need rapid insertion of pericardial drain
Pulmonary embolism if strongly suspected thrombolysis should be administered