ARC Resuscitation Guidelines Changes 2010


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Critical Care in the Vineyards. Thursday 28th and Friday 29th April, 2011

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ARC Resuscitation Guidelines Changes 2010

  1. 1. ARC Resuscitation Guidelines Changes 2010 <br />Shane Lenson<br />Senior Nurse Advisor, Royal College of Nursing, Australia<br />RCNA representative on the Australian Resuscitation Council<br />
  2. 2. Outline<br />About the ARC<br />Guideline development process<br />Changes to BLS<br />Changes to ALS<br />Changes to Paediatric BLS & ALS<br />
  3. 3. About the ARC<br />
  4. 4. Guideline development process<br />Australian and New Zealand Committee <br />on Resuscitation (ANZCOR)<br />
  5. 5. Changes to BLS<br />“S” Send for help<br />Early CPR<br />Effective CPR<br />Compression only CPR<br />
  6. 6. “S” is for “Send for help”<br />
  7. 7. 10 second breathing check<br />Check for “normal” breathing<br /><br />“normal” breathing not present<br /><br />Start CPR<br />No checking for pulse/s or “signs of life” required<br />
  8. 8. Compressions, Compressions, Compressions<br />Compressions remain at 30:2 at a rate of 100/min,1/3 chest depth for adults<br />2 breaths should be delivered in less than one second each<br />Compressions should be commenced with out delay.<br />Minimise interruptions<br />Plan interventions around CPR<br />No minimum period of CPR before defibrillation<br />
  9. 9. Compression only CPR<br />
  10. 10. Changes to ALS<br />Simple flow chart<br />Chest compressions whilst charging a manual defibrillator<br />Drug Delivery <br />Stacked Shocks<br />Other Changes<br />
  11. 11. New simple flow chart<br />
  12. 12. Continue chest compressions whilst charging a manual defibrillator<br />Process:<br />Team leader “prepare to charge”<br /><br />Defib controller “everyone apart from CPR stand clear, CPR continue”<br /><br />Defib controller ensures other people are clear, charges defib, once charged <br />“CPR stand clear” and ensures everyone is safe<br /><br />Team leader assesses rhythm as shockable or non shockable and takes action.<br />
  13. 13. Drug Delivery <br />ETT delivery no longer recommended<br />Greater focus on IO access<br />Administer Adrenaline<br />After the 2nd shock, then every second cycle<br />Immediately then every second cycle<br />Atropine is no longer recommended in cardiac arrest<br />Most drugs now only appear in special circumstances parts of the ARC guidelines <br />
  14. 14. Stacked Shocks<br />3 stacked shocks are only recommended in situations where defibrillation can be undertaken immediately. The arrest needs to be witness and monitored.<br />Examples<br />Critical care areas where the patient has defib pads in place, cath labs etc<br />
  15. 15. Other Changes<br />Increasing evidence for the use therapeutic hypothermia post ROSC<br />Waveform capnography is recommended during ALS management if available<br />Patient deterioration monitoring and management programs are highly recommended. <br />
  16. 16. Changes to Paediatric BLS & ALS<br />CPR<br />Defibrillation<br />
  17. 17. Paediatric CPR<br />Chest compression can be delivered at 15:2 for ALS providers starting with breaths.<br />Discourage compression only CPR in paediatrics<br />
  18. 18. Paediatric Defibrillation<br />Paediatric defibrillation should occur using a manual or paediatric SAED/AED with a dose attenuator where possible.<br />If all else fails...Adult SAED may be used for children from 1 -8 years<br />Paediatric shocks should commence at 4J/kg. No longer incremental changes.<br />
  19. 19. Get all the info you need!!!<br /><br />
  20. 20. Questions?<br />