In a shockable rhythm (VF or pVT), which medications are given and when?
The first dose of adrenaline 1mg IV is given during the 2 min cycle of CPR after delivery of the third shock. Amiodarone 300mg is given after 3 defibrillation attempts (so if giving stacked shocks intiailly then amiodarone would be given during first CPR cycle). Subseqent doses of adrenaline are given after alternate 2 min cycles of CPR (every 3 to 5 minutes) for as long as cardiac arrest persists. A further dose of 150mg amiodarone may be given after a total of five defibrillation attempts.
How is management of shockable rhythms different if the arrest is witnessed and monitored?
- If initial rhythm is VF/pVT, give up to three quick successive (stacked) shocks
- Rapidly check for a rhythm change and, if appropriate, check for a pulse and other signs of life after each defibrillation attempt.
- If this initial three shock strategy is unsucessful, follow the ALS algorithm and treat these three-shicks as if only the first single shock has been given.
- The first dose of adrenaline should be given after another two shock attempts if VF/pVT persists.
- Amiodarone is given after three shock attemps irrespective of when they are given during the cardiac arrest.
In a non-shockable rhythm (asystole or PEA), which medications are given and when?
Adrenaline 1mg IV is given as soon as IV access is achieved and then during alternate 2 minute cycles of CPR.
What should the depth and rate of chest compressions be?
Depth of 5 to 6cm.
Rate 100 to 120 per minute.
At what rate should ventiallation occur?
Initially 30 compression: 2 breaths. Once a SGA has been inserted, attempt to delver continuous chest compression, uninterrupted during ventilation. Ventilate at 10 breaths per minute.
What measures can help peripherally injected medications to be delivered to the central circulation?
Drugs injected peripherally should be followed by a flush of at least 20mls fo fluid and elevation of the extremity for 10-20s.
What are the 4 H’s and 4 T’s?
- Hypoxia
- Hypovolaemia
- Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, and other metabolic disorders
- Hypothermia/hyperthermia
- Thrombosis (pulmonary or coronary)
- Tension pneumothorax
- Tamponade - cardiac
- Toxins
How can ultrasound be useful during advanced life support?
In skilled hands, focused echocardiography/ultrasound can be useful for the detection of potentially reversible causes of cardiac arrest:
* cardiac tamponade
* pulmonary embolism
* ischaemia (regional wall motion abnormality)
* aortic dissection
* hypovolaemia
* pneumothorax
