Flashcards in ALS Algorithm Deck (11):
Shockable rhythms Epidemiology
Occur in 25% of cardiac arrests
Occur in 25% of non-shockable rhythms
Shockable rhythms treatment
1) Confirm the arrest
2) Call the resus team
3) Uninterrupted chest compressions whilst applying defib pads (below right clavicle and at V6 midaxillary position)
4) Tell team next actions (........)
5) Rhythm analysis, STOP COMPRESSIONS and confirm VF from ECG
6) Resume compressions immediately
6a) Team member selects 150-200J biphasic for first shock, 150-360J subsequent shocks) PRESS CHARGE
6b) While charge get everyone clear except for person performing compressions
6c) Once charge compression member stands clear, then GIVE SHOCK
6d) Restart 30:2 compressions. Continue for 2mins
7) Prepare team for next pause
8) Check rhythm STOP compressions
If still VF/VT continue repeat the above cycle and give second shock.
After second shock give a third shock. Resume compressions and give 1mg IV adrenaline and 300mg IV amiodarone without stopping compressions.
Repeat and give IV adrenaline only for alternate shocks.
A further 150mg of amiodarone can be given if VT/VF persists
Evidence of ROSC
Check carotid pulse
End tidal CO2
Start post resus care
If none continue CPR and switch to non-shockable algorithm
If asystole occurs then switch to non-shockable rhythms
Alternative to amiodarone?
Only appropriate in a monitored, witnessed arrest with many clinicians and defib not readily available.
Low success rate in shockable rhythms and only if given in the first few seconds of onset
More successful in pulseless VT than VF.
VT or VF in the cath lab
Confirm arrest and call for help
3 successive shocks (Count as 1 ALS shock)
Start chest compressions for 2 mins as normal
Start CPR 30:2-prepare Airway and IV access
Give adrenaline 1mg IV as soon as IV access is gained
Gain secure airway then continue compressions without pause
Recheck the rhythm after 2 mins
If organised electrical activity start post resus care
If no pulse: continue CPR
Recheck rhythm after 2mins
Give 1mg adrenaline every alternate CPR compression
Preferably supraglottic device used e.g. i-gel
Once inserted ventilation 10 per minute
Observe patient for 5mins before confirming death:
- Absent central pulse
- Absent heart sounds
- Asystole on ECG
- Absent contractile activity on ECHO
After 5mins check corneal/light reflexes before announcing time of death.
Reduction of the pre and post shock pause can influence the likelihood of success, because interruptions longer than 5 seconds reduce the chance of a shock restoring a spontaneous circulation. If it was considered appropriate to start resuscitation, it is usually worthwhile continuing whilst VF persists.
Pulse checks should be performed only when organised electrical activity compatible with a pulse is seen. Once given, adrenaline should be repeated every 3-5 minutes, irrespective of cardiac arrest rhythm.
In primary VF/VT, adrenaline is withheld until after the third shock. If ROSC occurs before the third shock, no adrenaline will have been given. If IV access cannot be achieved within 2 minutes of resuscitation, then intraosseous access should be considered. The initial dose of amiodarone is 300mg IV.