Basic Life Support Advanced Life Support In conjunction

Basic Life Support Advanced Life Support In conjunction with the remote simulation program simulation session Cardiac Module C 4 This project was possible due to funding made available by Health Workforce Australia

Sponsor This project was possible due to funding made available by Projects within NSW are overseen by the NSW Ministry of Health on behalf of HWA December 20 © Health Workforce Australia

Introductions December 20 © Health Workforce Australia

General Aims • Learn in a team setting • Blend clinical skills with team skills • Reflect critically on practice December 20 © Health Workforce Australia

Session Objectives • Recognition of cardiac arrest • Apply the ARC BLS algorithm early in cardiac arrest • Progress to the ARC ALS algorithm • Use a Defibrillator in ALS • Be familiar with drugs used in ALS December 20 © Health Workforce Australia

Ground Rules • • • December 20 Participation Privacy Confidentiality Disclaimer Debriefing Mobile phones © Health Workforce Australia

What criteria are used to declare cardiac arrest? December 20 © Health Workforce Australia

Recognition of cardiac arrest Not responsive DRS-ABCDE Commence CPR if not breathing or abnormal breathing December 20 © Health Workforce Australia

December 20 © Health Workforce Australia

Danger • Are staff & patient safe? – Hazards – PPE – Gloves – Eyewear – Mask – Gown December 20 © Health Workforce Australia

Response – Not responsive – Not breathing normally December 20 © Health Workforce Australia

Send for Help Arrest Call, 000 Send for senior help Send for a defibrillator December 20 © Health Workforce Australia

Airway Check airway Assess breathing Commence CPR December 20 © Health Workforce Australia

Breathing • 1 sec for each inspiration 1 • Compression-only CPR if rescuer unable / unwilling to perform rescue breaths • Alternatives: barrier device 2 December 20 © Health Workforce Australia

Circulation • CPR – Ratio 30: 2 – Compressions at a rate of 100/min – 1/3 AP chest diameter – “Go hard, go fast” December 20 © Health Workforce Australia

Defibrillation • Don’t wait! • AED will tell you • Manual defibrillator 200 J biphasic December 20 © Health Workforce Australia

When to check a rhythm • Once a defibrillator is available • After 2 min CPR • Sooner if responsiveness or normal breathing occur. • Charge the defibrillator before stopping CPR December 20 © Health Workforce Australia

Advanced Life Support • • • DRS ABCD plus Defibrillation using manual defibrillator IV/IO access Drugs Advanced airway techniques – Intubation – LMA placement December 20 © Health Workforce Australia

December 20 © Health Workforce Australia

Reversible Causes December 20 © Health Workforce Australia

Drugs used in ALS • Shockable Adrenaline 1 mg after 2 nd shock (then every 2 nd cycle) Amiodarone 300 mg after 3 rd shock • Non-shockable Adrenaline 1 mg immediately (then every 2 nd cycle) • At the time of recommencement of CPR. December 20 © Health Workforce Australia

Other Drugs Drug Indication Calcium Hypocalcaemia, hyperkalaemia, CCB OD Lignocaine substitute if amiodarone contraindicated Magnesium Torsade de pointes, dig toxicity, hypokalaemia, hypomagnesaemia Potassium Hypokalaemia Sodium bicarbonate TCA overdose, metabolic acidosis, >15 min arrest, hyperkalaemia Vasopressin Alternative to adrenaline (insufficient evidence) Thrombolytics In adult cardiac arrest patients with proven or suspected pulmonary embolism December 20 © Health Workforce Australia

Advanced Airway Placement • When skilled help is available • Ideally: <20 sec interruption to CPR • Then time with compressions – 6 -10 breaths per minute – do not pause compressions • Insert an LMA December 20 © Health Workforce Australia

Lets Practice This project was possible due to funding made available by Health Workforce Australia © Health

Scenario 1 • Mr Robbie Williams • 68 year old retired truck driver, presents with indigestion after eating a hamburger, has been triaged category 4. He has not seen a doctor in 45 years. • He has collapsed in the waiting room. December 20 © Health Workforce Australia

Scenario 2 • Mike Tyson • 27 year old male, dropped off by friends not breathing. The friends have left rapidly. • He need urgent assistance. December 20 © Health Workforce Australia

Summary • BLS uses the DRS ABCD algorithm • Early CPR and Defibrillation are the primary aims • Safe defibrillation techniques protect rescuers • Drugs and Airway skills are adjuncts to ALS • Communicate carefully in cardiac arrest situations December 20 © Health Workforce Australia

Acknowledgments C 4 Topic expert author: Sandra Cheng C 4 Simulation session author: Sandra Cheng Cardiac Module Expert Working Party and Peer Review Team Michael Bastick FACEM Gosford Hospital Sandra Cheng Simulation Fellow SCSSC John Kennedy FACEM Royal North Shore Hospital Marian Lee FACEM Prince of Wales Hospital John Mc. Kenzie FACEM Australian Institute for Clinical Education (AICE) Clare Richmond FACEM Royal Prince Alfred Hospital Morgan Sherwood Simulation Fellow SCSSC Timothy Tan Simulation Fellow SCSSC John Vassiliadis FACEM Royal North Shore Hospital Educational consultants: Stephanie O’Regan Nurse Educator SCSSC Leonie Watterson Director Simulation Division SCSSC John Vassiliadis Deputy Director SCSSC Clare Richmond FACEM Royal Prince Alfred Hospital Morgan Sherwood Simulation Fellow SCSSC December 20 © Health Workforce Australia

Disclaimer Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However the authors, editor and publisher are not responsible for errors or omissions or for any consequences from the application of the information in this presentation and make no warranty, express or implied, with respect to the contents of the presentation. Copyright and Permission to Reproduce This work is copyright. It may be reproduced for study or training purposes subject to the inclusion of an acknowledgement of the source: Health Workforce Australia Ed. WISE program. It may not be reproduced for commercial usage or sale. December 20 © Health Workforce Australia