Put italltogether06122011
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Put italltogether06122011 Put italltogether06122011 Presentation Transcript

  • PUT IT ALL TOGETHER ALS Subcommittee 2010
  • Collapsed patient Without cardiac output With cardiac output Shock-able rhythm• Tachyarrhythmias • Ventricular fibrillation• Bradyarrhythmias • Pulseless VT Non shock-able rhythm • Asystole • Pulseless electrical activity ALS Subcommittee 2010
  • VF / Pulseless VT•Avoid Danger•Check Responsiveness•Shout: Activate emergency response system Call for defibrillator and resus trolley• A Airway: open the airway• B Breathing: assess if no breathing or agonal breathing• C Circulation: give chest compressions• D Defibrillation: assess rhythm and shock VF/pulseless VT (360J monophasic or 120-200J biphasic) ALS Subcommittee 2010
  • VF / Pulseless VT …. cont Resume attempts to defibrillate 1 x 360 J (or equivalent biphasic)•Adrenaline 1 mg IV push, repeat every 3 to 5 minutes OR Vasopressin 40 U IV, single dose, 1 time only Chest Resume attempts to defibrillate compression 1 x 360 J (or equivalent biphasic) continues with Consider antiarrhythmics: minimal •Amiodarone 300mg bolus OR •Lignocaine 1mg/kg bolus interruptions •Magnesium ( known hypomagnesemic state) Resume attempts to defibrillate ALS Subcommittee 2010
  • Asystole / PEA•Avoid Danger•Check Responsiveness•Shout: Activate emergency response system Call for defibrillator and resus trolley• A Airway: open the airway• B Breathing: assess if no breathing or agonal breathing• C Circulation: give chest compressions• D Defibrillation: non-shockable rhythm ALS Subcommittee 2010
  • Asystole/ PEA ….cont• Adrenaline 1 mg IV push - repeat every 3 to 5 minutes - vasopression 40U may replace 1 dose of adrenaline• CPR• Drugs• Determine causes of PEA or Asystole - consider 6 Hs and 5 Ts ALS Subcommittee 2010
  • Asystole/ PEA ….cont• Consider quality of resuscitation?• Atypical clinical features present?• Consider ceasing resuscitation• Search for DNR order ALS Subcommittee 2010
  • Patient with pulse• Reassurance• Oxygen• IV access• Monitor ALS Subcommittee 2010
  • Tachyarrhythmias Stable Unstable• Medications • Cardioversion• ± maneuvers • Consider amiodarone after 3x cardioversion ALS Subcommittee 2010
  • Bradyarrhythmias• Symptomatic : medications ± pacing ALS Subcommittee 2010
  • Success Of CPR• Team effort: – good team members – good team leader – knowledge 11 ALS Subcommittee 2010
  • THANK YOUNATIONAL COMMITTEE ON RESUSCITATION TRAINING SUBCOMMITEE FOR ADVANCED LIFE SUPPORT  Dr Tan Cheng Cheng  Dr Luah Lean Wah  Dr Ismail Tan  Dr Wan Nasrudin  Dr Chong Yoon Sin  Dr Priya Gill  Dr Ridzuan bin Dato’ Mohd Isa  Dr Thohiroh Abdul Razak  Dr Adi Osman ALS Subcommittee 2010