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

1. ARC Resuscitation Guidelines Changes 2010 Shane Lenson Senior Nurse Advisor, Royal College of Nursing, Australia RCNA representative on the Australian Resuscitation Council

2. Outline About the ARC Guideline development process Changes to BLS Changes to ALS Changes to Paediatric BLS & ALS

3. About the ARC

4. Guideline development process Australian and New Zealand Committee on Resuscitation (ANZCOR)

5. Changes to BLS “S” Send for help Early CPR Effective CPR Compression only CPR

6. “S” is for “Send for help”

7. 10 second breathing check Check for “normal” breathing  “normal” breathing not present  Start CPR No checking for pulse/s or “signs of life” required

8. Compressions, Compressions, Compressions Compressions remain at 30:2 at a rate of 100/min,1/3 chest depth for adults 2 breaths should be delivered in less than one second each Compressions should be commenced with out delay. Minimise interruptions Plan interventions around CPR No minimum period of CPR before defibrillation

9. Compression only CPR

10. Changes to ALS Simple flow chart Chest compressions whilst charging a manual defibrillator Drug Delivery Stacked Shocks Other Changes

11. New simple flow chart

12. Continue chest compressions whilst charging a manual defibrillator Process: Team leader “prepare to charge”  Defib controller “everyone apart from CPR stand clear, CPR continue”  Defib controller ensures other people are clear, charges defib, once charged “CPR stand clear” and ensures everyone is safe  Team leader assesses rhythm as shockable or non shockable and takes action.

13. Drug Delivery ETT delivery no longer recommended Greater focus on IO access Administer Adrenaline After the 2nd shock, then every second cycle Immediately then every second cycle Atropine is no longer recommended in cardiac arrest Most drugs now only appear in special circumstances parts of the ARC guidelines

14. Stacked Shocks 3 stacked shocks are only recommended in situations where defibrillation can be undertaken immediately. The arrest needs to be witness and monitored. Examples Critical care areas where the patient has defib pads in place, cath labs etc

15. Other Changes Increasing evidence for the use therapeutic hypothermia post ROSC Waveform capnography is recommended during ALS management if available Patient deterioration monitoring and management programs are highly recommended.

16. Changes to Paediatric BLS & ALS CPR Defibrillation

17. Paediatric CPR Chest compression can be delivered at 15:2 for ALS providers starting with breaths. Discourage compression only CPR in paediatrics

18. Paediatric Defibrillation Paediatric defibrillation should occur using a manual or paediatric SAED/AED with a dose attenuator where possible. If all else fails...Adult SAED may be used for children from 1 -8 years Paediatric shocks should commence at 4J/kg. No longer incremental changes.

19. Get all the info you need!!! www.resus.org.au

20. Questions?