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Advanced Life Support Algorithm

The document outlines the advanced life support algorithm for treating cardiac arrest. It details the steps of assessing rhythm, delivering shocks or continuing CPR for shockable or non-shockable rhythms, administering drugs, and addressing potentially reversible causes. The goal is to restore normal cerebral function, heart rhythm, organ perfusion and quality of life through early recognition, CPR, defibrillation, advanced medical support, and post-cardiac arrest care.

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179 views

Advanced Life Support Algorithm

The document outlines the advanced life support algorithm for treating cardiac arrest. It details the steps of assessing rhythm, delivering shocks or continuing CPR for shockable or non-shockable rhythms, administering drugs, and addressing potentially reversible causes. The goal is to restore normal cerebral function, heart rhythm, organ perfusion and quality of life through early recognition, CPR, defibrillation, advanced medical support, and post-cardiac arrest care.

Uploaded by

mariam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Advanced Life Support

Algorithm

Emergency Medicine Department


Dr – Sherif Elfayoumy
Learning objectives
 The ALS Algorithm

 Treatment of shockable and non-shockable rhythms

 Potentially reversible causes of cardiac arrest

 post-cardiac arrest treatment


CPR is a series of lifesaving actions that improve the chance
of survival following cardiac arrest.
Successful resuscitation requires an integrated set of
coordinated actions represented by the links in the

Chain of survival
Chain of survival
 Early recognition and activation of EMT
 Immediate bystander CPR
 Early defibrillation
 Early advanced life support
 Integrated post-arrest care
Chain of survival
The goal is to restore:
 Normal cerebral function
 Stable cardiac rhythm
 Adequate organ perfusion
 Quality of life
Unresponsive

Open airway
Determination of signs of life Call
ALS resuscitation team
Algorithm CPR 30:2
Until defibrillator/monitor is
attached

Assess
rhythm

Shockable Non shockable


(VF/VT without pulse) (PEA/ Asystole)
During CPR
 Ensure high-quality CPR: rate, depth,
recoil
 Plan actions before interrupting CPR
1 Shock  Give oxygen
150-200 J Biphasic  Consider advanced airway
or 360 J Monophasic
 Continuous chest compressions when
advanced airway in place
 Vascular access (intravenous,
Immediately resume

intraosseous)
Give adrenaline every 3-5 min
Immediately resume
CPR 30:2  Correct reversible causes CPR 30:2
2 min. 2 min.
Check for sign of life
 Patient response

 Provide airway patency

 Check for normal


breathing
• Using look, listen, and
feel technique for not
more than 10 sec.

 Check circulation
No signs of life
Unresponsive
Determination of signs of
life

Call
resuscitation
team
Cardiac arrest
confirmation
Unresponsive
Determination of signs of
life

Call
resuscitation
team

CPR 30:2
Until
defibrillator/monitor is
attached
Chest compression
 30:2
 Compressions
 Centre of chest
 5-6 cm depth
 2 per second (100-120 min-1)
 Maintain high quality
compressions with
minimal interruptions
 Continuous compressions
once airway secured
 Switch CPR provider every
2 min cycle to avoid fatigue
Quick Evaluation of
rhythm
 Conduct ECG, classic
electrodes, or self adhesive
electrodes.
Quick Evaluation of
rhythm
Assess
rhythm

Shockable Non shockable


(VF/VT (PEA/
without pulse) Asystole)

Minimize Interruptions in Chest Compressions


Shockable rhythm(VF)

 Bizarre irregular waveform


 No recognisable QRS complexes
 Random frequency and amplitude
 Coarse/fine
Shockable rhytm(VT)

 Broad complex rhythm


 Rapid rate
 Constant QRS morphology
 Monomorphic / polymorphic
Shockable
rhythm(VF/pulseless VT )
Assess
rhythm

Shockable  First defibrillation


(VF/VT without pulse)
• 150-200 J biphasic
• 360 J monophasic
1 Shock
150-200 J Biphasic  Continue CPR for the
or 360 J Monophasic
next 2 min
Immediately resume
CPR 30:2
2 min.
If VF / VT persists
Deliver 2nd shock  2nd and subsequent
shocks
• 200 – 360 J biphasic
CPR for 2 min
• 360 J monophasic

Deliver 3rd shock


 Give adrenaline and
amiodarone after 3rd shock
during CPR
CPR for 2 min
During CPR
Adrenaline 1 mg IV
Amiodarone 300 mg IV
Non-shockable (Asystole)

 Absent ventricular (QRS) activity


 Atrial activity (P waves) may
persist
 Rarely a straight line trace
Non-shockable (Pulseless
Electrical Activity)

 Clinical features of
cardiac arrest
 ECG normally
associated with an
output
Non-shockable
(PEA/Asystole)
Assess
rhythm

 During CPR
• Check for electrode Non shockable
(PEA/ Asystole)
connection
• Adrenaline 1 mg IV then
every 3-5 min
Immediately resume
CPR 30:2
2 min.
Airway and ventilation
during CPR
 Secure airway:
 Supraglottic airway device e.g.
LMA, LT, I-gel
 Tracheal tube
 Do not attempt intubation
unless trained and competent
to do so
 Once airway secured, if
possible, do not interrupt chest
compressions for ventilation
 Avoid hyperventilation
Key points during CPR
 Ensure high-quality CPR: rate, depth, recoil
 Plan actions before interrupting CPR
 Give oxygen
 Consider advanced airway
 With advanced airway, compressions at 100-120/min ventilations
at 10-12 breaths /min
 Vascular access (intravenous, intraosseous)
 Drugs in peripheral lines- 20 ml chase fluids and elevate limb
 Give adrenaline every 3-5 min
 Avoid provider fatigue by rotation
 Rule out the 4Hs and 4Ts reversible causes
Reversible causes
Hypoxia
 Ensure patent airway

 Give high-flow
supplemental oxygen

 Avoid hyperventilation
Hypovolaemia
 Seek evidence of
hypovolaemia
 History
 Examination
• Internal haemorrhage
• External haemorrhage
• Check surgical drains

 Control haemorrhage
 If hypovolaemia
suspected give
intravenous fluids
Hypo/hyperkalaemia and
metabolic disorders
 Near patient testing for
K+ and glucose
 Check latest laboratory
results
 Hyperkalaemia
 Calcium chloride
 Insulin/dextrose
 Hypokalaemia/
Hypomagnesaemia
 Electrolyte
supplementation
Hypothermia
 Rare if patient is an
in-patient
 Use low reading
thermometer
 Treat with active
rewarming techniques
 Consider
cardiopulmonary bypass
Tension pneumothorax
 Check tube position if
intubated
 Clinical signs
 Decreased breath
sounds
 Hyper-resonant
percussion note
 Tracheal deviation
 Initial treatment with
needle decompression or
tube thoracostomy
Cardiac tamponade
 Difficult to diagnose
without
echocardiography
 Consider if penetrating
chest trauma or after
cardiac surgery
 Treat with needle
pericardiocentesis or
resuscitative
thoracotomy
Thrombosis
 If high clinical
probability for PE
consider fibrinolytic
therapy

 If fibrinolytic therapy
given continue CPR for
up to 60-90 min before
discontinuing
resuscitation
Toxins
 Rare unless evidence of
deliberate overdose
 Review drug chart
Immediate post-cardiac arrest
treatment
 Use ABCDE approach
 Controlled oxygenation
and ventilation
 12 lead ECG
 Treat precipitating cause
 Temperature control /
therapeutic hypothermia
Any
questions
Summary
 The ALS algorithm
 Treatment of shockable and
non-shockable rhythms
 Administration of drugs
during cardiac arrest
 Potentially reversible causes
of cardiac arrest
 post-cardiac arrest
treatment

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