Dr Nishith Govil Dr Kumar Parag

BLS assessment
• Check responsiveness

• Shout for help

• Activate ERS

• Get AED/ Defibrillator

• Check breathing and Pulse

• Defibrillate/ high Quality CPR

Primary Assessment

• Airway

• Breathing

• Circulation

• Disability

• Exposure
Airway

• Patency: HTCL, OA, NPA

• Advance airway: LMA, ETT

• Synchronization of Compression and ventilation

• Confirmation of proper placement

• Secure

• Monitoring with continuous quantitative waveform capnography

Breathing

• Monitor with oxyhemoglobin saturation

• Administer 100 % oxygen

• Target SpO2 94 % or greater

• Avoid excessive ventilation

• 10 breaths per minute for adults

• 20 - 30 breaths per minute for pediatric

Circulation

• Attach Monitor for rhythm analysis

• Provide Defibrillation as per rhythm analysis

• Obtain IV/IO access

• Give fluid if needed

• Use appropriate Drugs

• Check Glucose and Temperature

Disability and Exposure

• Check for neurological function

• Responsiveness : alert, Voice, Pain, Unresponsiveness

• Level of consciousness

• Pupil Dilatation

• Physical examination for obvious cause of arrest

Secondary Assessment
High Quality CPR
• Push Hard (2 inches or 5 cm)
• Push fast (100 -120 / min)
• Minimize interruptions to < 10 sec
• Avoid excessive ventilation
• Allow chest recoil
• Target PETCO2 > 10 mm Hg
• Target diastolic pressure > 20 mm Hg (intraarterial pressure)
Defibrillation
• High energy unsynchronized shocks
• 120 – 200 J biphasic
• Manual defibrillator preferred over AED
• Stunning of heart
• Caution for oxygen flowing over the chest
• Use sedation
• SVT/ Atrial Flutter 50J, Mono VT 100J, AF 200J
Drugs in ACLS

• Epinephrine 1 mg every 3 – 5 minutes

• Amiodarone 300 mg Ist dose; 150 mg 2nd Dose

• Atropine 0.5mg bolus every 3-5 min, max 3 mg

• Dopamine 2-20 mcg/kg/min

• Epinephrine 2-20 mcg/min

• Adenosine 6 mg bolus f/b 12 mg if required

ROSC
• Titrate Spo2 to 92-98%
• PaCO2 35-45 mm Hg
• SBP > 90 mm Hg
• MAP > 65 mm Hg
• Use fluid and inotropes
• Lung protective ventilation
• TTH 32-36 degree C for 24 hour
Multimodal Neuroprognostication

• 12 lead ECG; cardiac intervention if STEMI

• Normoxia, normocapnia, euglycemia if awake

• TTM, Brain CT, upto 24 hour if comatose

• After 24 hour upto 72 hour; MRI, EEG, serum NSE, rewarming

• Prognostication done 72 hour after normothermia and limiting

sedation
CPR (BLS) in COVID patients
• Interim Guidance for Basic and Advanced Life Support in Adults,
Children, and Neonates With Suspected or Confirmed COVID-19

• Circulation. 2020;141:e933–e943.
DOI:10.1161/CIRCULATIONAHA.120.047463
Dana P. Edelson. Circulation. Interim Guidance for Basic and
Advanced Life Support in Adults, Children, and Neonates With
Suspected or Confirmed COVID-19, Volume: 141, Issue: 25,
Pages: e933-e943, DOI:
(10.1161/CIRCULATIONAHA.120.047463) © 2020 American Heart Association, Inc.
Reduce exposure

• Move to a negative pressure room

• Close the door

• Don PPE

• Reduce personnel

• Consider Mechanical CPR device

• Communicate COVID status

Limit Aerosolization
• Perform at least Hands only CPR

• Cover face and nose with a cloth

• Passive oxygenation with nonrebreathing face mask

• Bag and Mask device with tight seal and hepa filter

• Intubate early by an experienced intubator

• Minimise close circuit disconnection

• Use close suction catheter