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Fig 1.2_Adult BLS Final

Shout for help

Open airway

NOT BREATHING NORMALLY?

Call 112*

2 rescue breaths30 compressions

30 chest compressions

Adult Basic Life Support

UNRESPONSIVE?

*or national emergency number

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Fig 1.4_BLS-AED Final

unresponsive?

Call for help

Send or go for AEDCall 112*

Open airwayNot breathing normally

CPR 30:2until AED is attached

Shockadvised

No shockadvised

1 Shoc

Immediately resme:CPR 30:2for 2 min

Immediately resme:CPR 30:2for 2 min

Contine ntil the victim startsto wae p: to move, opens

eyes and to breathe normally

AED

assessesrhythm

*or national emergency nmber

Automated External Defibrillator Algorithm

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Fig 1.3_Adult FBAO Final

Assess severity

Mild airway obstruction(effective cough)

Severe airway obstruction(ineffective cough)

Unconscious

Start CPR

Conscious

5 back blows5 abdominal thrusts

Encourage cough

Continue to checkfor deterioration

to ineffective cough oruntil obstruction relieved

Adult Foreign Body Airway Obstruction Treatment

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Fig 1.5_InHospital Resuscitation Final

Collapsed/sick patient

Shout for HELP & assess patient

Assess ABCDERecognise & treat

Oxygen, monitoring, iv access

Call resuscitation teamIf appropriate

Handover to resuscitation team

Call resuscitation team

CPR 30:2with oxygen and airway adjuncts

Apply pads/monitorAttempt debrillation if appropriate

Advanced Life Supportwhen resuscitation team arrives

In Hospital Resuscitation

No YesSigns of life?

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Fig 1.6_Adlt ALS Final

unresponsive?Not breathing or only occasional gasps

CallResscitation Team

CPR 30:2Attach defibrillator/monitor

Minimise interrptions

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

1 Shoc

Immediately resme:CPR for 2 min

Minimise interrptions

Immediately resme:CPR for 2 min

Minimise interrptions

Retrn ofspontaneos

circlation

Assessrhythm

During CPR

Ensre high-qality CPR: rate, depth, recoil Plan actions before interrpting CPR

Give oxygen Consider advanced airway and capnography Continos chest compressions when advanced airway in place Vasclar access (intravenos, intraosseos) Give adrenaline every 3-5 min Correct reversible cases

Reversible causes

Hypoxia Hypovolaemia

Hypo-/hyperalaemia/metabolic Hypothermia

Thrombosis Tamponade - cardiac Toxins Tension pnemothorax

Immediate post cardiac

arrest treatment

use ABCDE approach Controlled oxygenation and

ventilation 12-lead ECG Treat precipitating case Temperatre control / therapetic

hypothermia

Advanced Life Support

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Fig 1.8_Bradycardia Final

Assess sing the ABCDE approach

Ensre oxygen given and obtain IV access

Monitor ECG, BP, SpO2 ,record 12 lead ECG

Identify and treat reversible cases (e.g. electrolyte abnormalities)

Risk of asystole? Recent asystole

Mbitz II AV bloc Complete heart bloc with broad QRS Ventriclar pase > 3s

Atropine

500 mcg IV

SatisfactoryResponse?

Assess for evidence of adverse signs:1 Shoc2 Syncope3 Myocardial ischaemia4 Heart failre

Interim measures: Atropine 500 mcg IV repeat to maximm of 3 mg Isoprenaline 5 mcg min-1

Adrenaline 2-10 mcg min-1

Alternative drgs*

OR Transctaneos pacing

* Alternatives inclde:

Aminophylline Dopamine Glcagon (if beta-blocer or calcim channel

blocer overdose) Glycopyrrolate can be sed instead of atropine

Bradycardia Algorithm

See expert helpArrange transvenos pacing

No

Yes No

Yes

Observe

No

Yes

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Fig 1.9_ACS Defnitons Final

Patient with clinical signs and symptoms of ACS

= NSTEMI if troponins(T or I) positive

= UAP if troponinsremain negative

STEMI

ST elevation 0.1 mV in 2 adjacent limb leads and/

or 0.2 mV in adjacent chest leadsor (presumably) new LBBB

Other ECG alterations(or normal ECG)

12 lead ECG

non-STEMI-ACSHigh risk dynamic ECG changes ST depression haemodynamic/rhythm instability diabetes mellitus

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Fig 1.10_ACS Treatment Final

Pain relief Nitroglycerin sl if systolic BP> 90 mmHg Morphine (repeated doses) of 3-5 mg until pain free

Antiplatelet treatment 160-325mg Acetylsalicylic acid chewed tablet (or iv)75 600 mg Clopidogrel according to strategy*

Early invasive strategy#

UFH

Enoxaparin or bivalirudin may be considered

Conservative

or delayed invasive strategy#

UFH (fondaparinux or bivalirudin may be

considered in pts with high bleeding risk)

STEMI

Thrombolysis preferred if

no contraindications and

inappropriate delay to PCI

Adjunctive therapy:

UFH, enoxaparin or fondaparinux

PCI preferred if

timely available in a high volume center

contraindications for brinolysis

cardiogenic shock (or severe left

ventricular failure)

Adjunctive therapy:

UFH, enoxaparin or bivalirudin may be

considered

ECG

Non-STEMI-ACS

# According to risk stratication

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Fig 1.11_Paed BLS Final

Shout for help

Open airway

NOT BREATHING NORMALLY?

5 rescue breaths

2 rescue breaths30 compressions

NO SIGNS OF LIFE?

30 chest compressions

Paediatric basic life support

UNRESPONSIVE?

After 1 minute of CPR call 112 or national emergency number

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Fig 1.12_Paed FBAO Final

Assess severity

Effective coughIneffective cough

Unconscious

Open airway5 breathsStart CPR

Conscious

5 back blows5 thrusts

(chest for infant)

(abdominal for child> 1 year)

Encourage cough

Continue to check fordeterioration to ineffectivecough or until obstruction

relieved

Paediatric Foreign Body Airway ObstructionTreatment

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Fig 1.13 Paed ALS Final

unresponsive?Not breathing or only occasional gasps

Call ResscitationTeam

(1 min CPR first, if alone)

CPR (5 initial breaths then 15:2)Attach defibrillator/monitor

Minimise interrptions

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

1 Shoc 4 J/kg

Immediately resme:CPR for 2 min

Minimise interrptions

Immediately resme:CPR for 2 min

Minimise interrptions

Retrn ofspontaneos

circlation

Assessrhythm

During CPR

Ensre high-qality CPR: rate, depth, recoil Plan actions before interrpting CPR

Give oxygen Vasclar access (intravenos, intraosseos) Give adrenaline every 3-5 min Consider advanced airway and capnography Continos chest compressions when advanced airway in place Correct reversible cases

Reversible causes

HypoxiaHypovolaemia

Hypo-/hyperalaemia/metabolic Hypothermia

Tension pnemothorax Toxins Tamponade - cardiac Thromboembolism

Immediate post cardiac

arrest treatment

use ABCDE approach Controlled oxygenation and

ventilation Investigations Treat precipitating case Temperatre control Therapetic hypothermia?

Paediatric Advanced Life Support

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Dry the babyRemove any wet towels and cover

Start the cloc or note the time

If gasping or not breathingOpen the airway

Give 5 ination breathsConsider SpO2 monitoring

If chest not moving

Rechec head position

Consider two-person airway controlor other airway manoevresRepeat ination breaths

Consider SpO2 monitoring

Loo for a response

Reassess heart rateevery 30 seconds

If the heart rate is not detectable or slow (< 60)Consider venos access and drgs

If no increase in heart rateLoo for chest movement

When the chest is movingIf the heart rate is not detectable or slow (< 60)

Start chest compressions3 compressions to each breath

Newborn Life Support

ATA

LLSTAGE

SASk:D

OY

OuN

EEDHELP?

Acceptable*

pre-ductal SpO2

2 min : 60%3 min : 70%

4 min : 80%

5 min : 85%

10 min : 90%

Assess (tone),breathing and heart rate

30 sec

60 sec

Birth

Re-assess

If no increase in heart rate

Loo for chest movement