‘Advanced Life Support’

For the unresponsive patient- not breathing, no pulse

  1. Check for a response
    1. Verbal or pain (pinch shoulders)
  2. Check for airway/breathing/pulse
    1. Put the patient in the head tilt/chin lift position and put your ear to their mouth, looking at their chest movement, listening for breath sounds and feeling for breath
    2. Max 10 secs
  3. Shout for help / Call resus team (2222)
  4. Start CPR straight away
    1. 30:2 chest compressions to rescue breaths (begin with compressions) at around 100 compressions a minute.  Around 1/3rd of the chest should be compressed.
    2. If available, use the breathing bag mask (make sure there is a tight seal over the patient)
  5. When resus arrives- set up monitor/defibrillator
    1. One pad (white lead) over the right clavicle and another (red lead) over the mid-axillary line (5th intercostal space) in the V6 lead position
    2. Switch on and monitor the heart rhythm.  If in ventricular fibrillation or ventricular tachycardia, it is shockable.  If not, DO NOT shock.
    3. Switch to 150J biphasic shock and charge
    4. Once charged, CLEAR the area of oxygen and bodies, then deliver the shock.
    5. Resume CPR immediately.
    6. Reassess rhythm.  If, after 2 mins of CPR (10 breaths), nothing has changed, reshock.
    7. Repeat.  If still in VT/VF after 3 shocks, 300mg of amiodarone and 1mg of adrenaline IV may be given to aid.  If goes back to sinus rhythm and shows signs of life, manage as an acute care (ABCDE) patient.  In no signs of life (and sinus rhythm) continue CPR.

Reversible Causes of Cardiac Arrest/Collapse

  • Hypoxia
  • Hypovolaemia
  • Hypothermia/Hyperthermia
  • Hypokalaemia/Hyperkalaemia
  • Hypoglycaemia
  • Hydrogen (acidosis)
  • Tension pneumothorax
  • Tamponade (cardiac)
  • Toxins
  • Thromboembolism

For the unresponsive patient- not breathing but has a pulse

  • As above BUT instead of CPR- ventilate at around 10 breaths/minute and reassess pulse every minute
    • If there is uncertainty whether there is a pulse or if the pulse disappears, start CPR as above immediately.

For the ‘Acutely Unwell Patient’- see here

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