Advanced cardiac life support

Group : Aden, Eichman, Lucy, Jackie, Victor

Presenter: Alice
ACLS: include
• Endotrachel intubation.
• Electrical defibrillation
• Pharmacologcal intervention
 Causes of cardiac arrest
Hs and Ts
• Hypovolaemia
• Hypoxia
• Hypothermia
• Hypo/hyperkalemia
• H+ ion(acidosis)
• Toxins, tamponade, trauma
• Tension pneumothorax, throbosis(coronary/PE
Paediatric
ALS algorithm
 Paediatric ALS algorithm

Assess responsiveness and ABC

Immediately start CPR ensuring high
concentration of oxygen is being used with
BMV
Continue resuscitation while waiting on arrival
of resuscitation team
Attach monitor as soon as available ensure
correct placement of electrodes / pads -
rhythm can be monitored through ECG leads /
adhesive pads and paddles
 Paediatric ALS algorithm

Assess rythm – shockable or non- shockable.

Non-shockable rhythms most likely in
paediatric age group so will look at
management of these first.
Pulse palpation for 10 seconds cannot give a
reliable measurement of the presence or
absence of an effective circulation. The
presence or absence of signs of life should also
be use e.g. response to stimuli, normal
breathing or spontaneous movement
Non-shockable (PEA / Asystole)
Non-Shockable

Asystole
Asystole – check patient, check leads (I, II, III),
check gain, check electrodes. It is rarely a
straight line
Non-shockable (PEA / Asystole)
Non-Shockable

Pulseless electrical activity (PEA)

PEA – a clinical state characterised by organised electrical activity in

the absence of palpable pulse
QRS complex could be wide or narrow, slow or fast
 Assess
Non-shockable algorithm
rhythm
Non-Shockable
(PEA / Asystole)

Immediately resume
CPR for 2 min
Adrenaline Minimise interruptions
10 mcg kg-1 as soon as IV access
is obtained and then
every second loop or
every 3 - 5 mins

On diagnosis of rhythm, immediately resume CPR

Adrenaline can be given as soon as vascular access is obtained and
then every other loop in the algorithm
Pause briefly at the end of the two minute cycle to confirm rhythm on
monitor
Continue with 2 minute cycles
During any cardiorespiratory arrest, continually seek and treat 4 H’s
and 4 T’s
Shockable (VF / Pulseless VT)
Shockable

Ventricular fibrillation (VF)

Chaotic, disorganised series of depolarisations
Shockable rhythms can occur in 27% of in-hospital cardiorespiratory
arrests in children often as a reperfusion rhythm, its incidence being
highest in children over 8 years and in the under 1 year age group.
Suspect in child with underlying cardiac disease, history of ingestion of
drugs
 Shockable

Shockable(VF / Pulseless VT)

Pulseless ventricular tachycardia (VT)

Uncommon in children
Child may have underlying heart disease (post
cardiac surgery, cardiomyopathy, myocarditis,
electrolyte disturbances, prolonged Q-T
interval)
Drug ingestion
 Shockable algorithm
A DC shock of 4J/kg should be administered as soon as
defibrillator available
Immediately resume 2 minute cycle of CPR without rhythm
check Assess
If not already, obtain vascular access rhythm
Brief pause at end of CPR cycle to confirm rhythm followed
by further DC shock at 4J/kg
Adrenaline given immediately after the 3rd shock and given
every second loop thereafter
Amiodarone should be given immediately after the 3rd shock Shockable
and repeated after the 5th shock if VF/pulseless VT persists
Continue in 2 minute cycles (VF / Pulseless VT)
Continually seek and treat reversible causes!

1 Shock
4J / kg
Adrenaline
10 mcg kg-1
after the 3rd shock
and then every 3 - 5 mins Immediately resume
CPR for 2 min
Amiodarone Minimise interruptions
5 mg kg-1
after the 3rd and 5th shocks
During CPR/ Reversible causes
ROSC
 Resuscitation team

• Roles should be planned in advance

• Identify team leader
• Plan interruptions to minimise breaks in chest
compressions
 Team members
(TM6)
(TM1)
Parents
Airway /Ventilation

(TM3)
(TM2) Defibrillation
Chest compressions/pulse

(TM4)
IV access/drugs (TM5)
Scriber/drugs

(TL) Team Leader

 Summary

• PALS algorithm
• Non-shockable and shockable rhythms
• Potentially reversible causes
• Administration of drugs during
cardiorespiratory arrest
• Role of the resuscitation team
 ADULT ATLS
• Intubation : will give swift control of airway
with minimal interruptions in chest
compressions and no delay in defibrillation.
• Optimize oxygenation and removal of co2.
• Drugs given in ETT: naloxone,atropin,
vasopressin, epinephrine and lidocaine)
NAVEL
 TO SHOCK OR NOT ?
SHOCKABLE RHYTHMS DO NOT SHOCK

• Ventricular fibrillation • Asystole

• Ventricular tachycardia( • Pulseless electrical

no pulse) activity
defibrillation
• 1 shock, continue CPR while charging
• Biphasic-manual ( 120-200)J
• Monophasic: 360 J
• Resume CPR immediately after shock
• Drugs: Epi 1mg q 3-5 minutes. 1 dose of vasopressin 40 iu(controversial)
btn 1st and 2nd dose of Epi.
• Antiarrythimics :amiadarone 300mg rpt150mg once or lidocaine 1-
1.5mg/kg stat then 0.5-0.75 mg/kg q 5-10min max 3mg/kg.
• Magnesium: 1-2 g IV if torsades de pointes
 REVERSIBLE CAUSES
• Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade ( cardiac)
• Hydrogen ion ( acidosis) • Toxins
• Hypo/ hyperkalaemia • Thrombosis
• hypothermia (pulmonary)
• Thrombosis (coronary)
 How long?
When do you stop CPR?
• AED available and ready to use
• Obvious signs of life
• Another trained personnel takes over
• Scene becomes unsafe
• Obvious death-decapitation, rigor mortis
• Physical fatigue.
• More than 30 minutes without signs of life-toddler revived after 1hr 41 minutes.
AHA.younger the patient the longer the resuscitation time

• AED-automated external defibrillator.

 POST ARREST CARE
• After ROSC
• Multidisciplinary

• Neuroprotection
– ventilation
– Sedation
– Temperature control
– Glucose control
 Post arrest care

• sedation

• Temperature control
– Targeted temperature control

• Glucose control
– Maintain blood glucose ≤ 10mmol/l (180mg/dl)
– Avoid hypoglycemia
•Thank you