Put italltogether06122011

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Put italltogether06122011

  1. 1. PUT IT ALL TOGETHER ALS Subcommittee 2010
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. Asystole/ PEA ….cont• Consider quality of resuscitation?• Atypical clinical features present?• Consider ceasing resuscitation• Search for DNR order ALS Subcommittee 2010
  8. 8. Patient with pulse• Reassurance• Oxygen• IV access• Monitor ALS Subcommittee 2010
  9. 9. Tachyarrhythmias Stable Unstable• Medications • Cardioversion• ± maneuvers • Consider amiodarone after 3x cardioversion ALS Subcommittee 2010
  10. 10. Bradyarrhythmias• Symptomatic : medications ± pacing ALS Subcommittee 2010
  11. 11. Success Of CPR• Team effort: – good team members – good team leader – knowledge 11 ALS Subcommittee 2010
  12. 12. 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

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