Advanced cardiac resuscitation guidelines
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Advanced Cardiac Resuscitation Guidelines - PowerPoint PPT Presentation

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

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  • Determine if the patient is conscious by tapping and shouting "Are you OK?" If no response have someone call for the crash cart

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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

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BLS - Breathing

  • LOOK-LISTEN-&-FEELING for breaths


  • If they isn’t breathing VENTILATE TWICE -Rescue Breathing

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BLS- Circulation Check

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

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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

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  • 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

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Advanced Life Support

  • Recommended Minimum Equipment for the Management of Adult Cardiopulmonary Arrest


  • Self inflating resuscitation bag with oxygen reservoir and tubing -BVM

  • Laryngoscopes x 2 - normal and long blades

  • Spare laryngoscope bulbs and batteries

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  • 1" ribbon gauze/tape

  • Scissors

  • Syringe - 20 mls

  • Oxygen cylinders x 2 (if no wall oxygen)

  • KY Jelly

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ALS - 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

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Basic ALS Drugs


  • Adrenaline / Epinephrine 1 mg (1:1000)

  • Atropine 3 mgs

  • Amiodarone 300mgs

  • Phenergan

  • Hydrocortisone

  • Lignocaine

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ALS - Additional Equipment


  • ECG Electrodes

  • Defibrillation Gel pads

  • Pulse Oximeter

  • Gloves/Goggles/Aprons

  • NIBP Monitor

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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).

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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

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ALS- Rhythm Recognition


  • 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.

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  • Ventricular Fibrillation

  • Asystole

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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

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ALS- Advanced Airway

  • Prepare Equipment

  • Insert Airway

  • Check Position

  • Ventilate

  • Consider Surgical Airway -Cricothyroidotomy

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ALS- Drug Therapy



  • 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

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ALS- Drug Therapy


  • Used in Asystole and PEA

  • Mech.. Of Action : Vagolytic Drug

  • Given at a dose of 1mg every 3 minutes till a maximum of 3mg

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ALS- Drug Therapy


  • Used in persistent VF that remains despite adrenaline

  • Used post 2nd defibrillation attempt

  • 300mgf bolus given mixed with 20ml of dextrose

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Clinical Features

  • Urticaria (hives) and/or angioedema

  • Hypotension -Shock

  • Upper Resp Tract Obstruction.

  • Bronchospasm

  • Cyanosis

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  • Prevention

  • ALS- Airway Protection,Breathing, Circulation

  • Adrenaline (0.5ml IMI & Nebulised & IV)

  • Antihistamines (Promethazine 25mg)

  • Adrenergic Agonists (Salbutamol Nebs)

  • Hydrocortisone (200mg IVI)

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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