This document provides guidelines for responding to different types of cardiac arrest and arrhythmia. It outlines the steps for cardiopulmonary resuscitation (CPR) and use of defibrillators for shockable rhythms like ventricular fibrillation and pulseless ventricular tachycardia. It also describes the treatment approach for non-shockable rhythms like asystole and pulseless electrical activity. The guidelines emphasize high-quality chest compressions, use of medications like epinephrine, and considering reversible causes of arrhythmia or cardiac arrest. It acknowledges that success of resuscitation efforts depends on having a knowledgeable team that works together effectively under good leadership.

1. PUT IT ALL TOGETHER

2. Collapsed patient
With cardiac output
• Tachyarrhythmias
• Bradyarrhythmias
Without cardiac output
Shock-able rhythm
• Ventricular fibrillation
• Pulseless VT
Non shock-able rhythm
• Asystole
• Pulseless electrical
activity

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 Defib VF/pulseless VT
(360J monophasic or 200J biphasic) x 1st shock

4. VF / Pulseless VT …. cont
•Adrenaline 1 mg IV push, repeat every 3 to 5 minutes
•Establish airway by intubation
Resume attempts to defibrillate 360 J (or
equivalent 200 J biphasic) – 3rd shock
Consider antiarrhythmics:
•Amiodarone 300mg bolus OR
•Lignocaine 1mg/kg bolus
•Magnesium ( known hypomagnesemicstate or a/w
Torsades de Pointes)
Resume attempts to defibrillate
High Quality
Chest
Compression
continues
with
minimal
interruptions
Resume attempts to defibrillate 360 J (or
equivalent 200Jbiphasic) – 2nd shock

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

6. Asystole/ PEA ….cont
• Adrenaline 1 mg IV push
- repeat every 3 to 5 minutes
• High quality CPR
• Drugs
• Determine reversible causes of PEA or Asystole
- consider 5 H's and 5 T's

7. Asystole/ PEA ….cont
• Consider quality of resuscitation?
• Atypical clinical features present?
• Consider ceasing resuscitation
• Search for DNR order

8. Patient with pulse
• Reassurance
• Oxygen
• IV access
• Monitor

9. Tachyarrhythmias
Stable
• Medications
• ± maneuvers
Unstable
• Sync Cardioversion
• Consider amiodarone
after 3x cardioversion

10. Bradyarrhythmias
• Symptomatic : medications ± pacing

11. Success Of CPR
• Team effort:
– good team members
– good team leader
– knowledge

12. THANK YOU
NATIONAL 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