This document provides guidelines for advanced life support (ALS) procedures. It outlines the steps for responding to collapsed patients with or without a cardiac output. For shockable rhythms like ventricular fibrillation and pulseless ventricular tachycardia, the guidelines specify performing chest compressions, defibrillation, adrenaline administration and considering antiarrhythmics. For non-shockable rhythms like asystole and pulseless electrical activity, the focus is on chest compressions, adrenaline administration and identifying potential causes. The document also covers guidelines for stable and unstable tachyarrhythmias and bradyarrhythmias, as well as factors that contribute to the success of cardiopulmonary resuscitation.

1. PUT IT ALL TOGETHER
ALS Subcommittee 2010

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. 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. 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. 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. 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. Asystole/ PEA ….cont
• Consider quality of resuscitation?
• Atypical clinical features present?
• Consider ceasing resuscitation
• Search for DNR order
ALS Subcommittee 2010

8. Patient with pulse
• Reassurance
• Oxygen
• IV access
• Monitor
ALS Subcommittee 2010

9. Tachyarrhythmias
Stable Unstable
• Medications • Cardioversion
• ± maneuvers • Consider amiodarone
after 3x cardioversion
ALS Subcommittee 2010

10. Bradyarrhythmias
• Symptomatic : medications ± pacing
ALS Subcommittee 2010

11. Success Of CPR
• Team effort:
– good team members
– good team leader
– knowledge
11
ALS Subcommittee 2010

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
ALS Subcommittee 2010