The Universal Treatment Algorithm An important part of

The Universal Treatment Algorithm An important part of Advanced Cardiac Life Support

Objectives n n n Recognise the four cardiac arrest rhythms Identify correctly the appropriate algorithm for each of the rhythms Discuss the potential reversible causes of cardiac arrest

BLS Algorithm if appropriate Precordial Thump Attach Monitor/Defib Assess rhythm +/- Pulse Check NON VF/VT VF / VT DEFIB X 3 as necessary During CPR Correct reversible causes CPR 1 MIN Check electrode / paddle positions Attempt/verify airway/02/IV access Give adrenaline every 3 mins ? buffers/atropine/ pacing/antiarrhythmics CPR 3 min Re-assess one minute after defibrillation

BLS Algorithm if appropriate Precordial Thump if appropriate Attach Monitor/Defib Assess rhythm +/- Pulse Check ? VF / VT Non VF / VT

BLS Algorithm if appropriate Precordial Thump Attach Monitor/Defib Assess rhythm +/- Pulse Check VF / VT DEFIB X 3 as necessary CPR 1 MIN During CPR Correct reversible causes Check electrode / paddle positions Attempt/verify airway/02/IV access Give adrenaline every 3 mins ? buffers/atropine/ pacing/antiarrhythmics

BLS Algorithm if appropriate Precordial Thump Attach Monitor/Defib Assess rhythm +/- Pulse Check NON VF/VT During CPR Correct reversible causes Check electrode / paddle positions Attempt/verify airway/02/IV access Give adrenaline every 3 mins ? buffers/atropine/ pacing/antiarrhythmics CPR 3 min Re-assess one minute after defibrillation

Potentially Reversible Causes Hypoxia Hypovolemia Hyper/ Hypokalemia and metabolic disturbances Hypothermia Tension pneumothorax Tamponade Toxic/ therapeutic disturbances Thrombo-embolic/ mechanical obstruction

Epinephrine (Adrenaline) n n First line cardiac arrest drug, given after every 3 minutes of CPR Dose 1 mg (10 ml of 1 in 10, 000) IV Causes vasoconstriction, increased systemic vascular resistance increasing cerebral and coronary perfusion Increases myocardial excitability, when the myocardium is hypoxic or ischaemic

Amiodarone n n n For Refractory VF/VT; haemodynamically stable VT and other resistant tachyarrhythmias If VF or pulseless VT persists after the first 3 shocks then Amiodarone 300 mg is considered. If not pre-diluted, must be diluted in 5% dextrose to 20 ml. (Will crystallise is mixed with saline) Should be given centrally but in an emergency can be given peripherally Increases the duration of the action potential in the atrial and ventricular myocardium

Calcium n n Administered when pulseless electrical activity caused by: Hyperkalaemia Hypocalcaemia Overdose of Calcium channel blocking drugs Dose 10 ml of 10% calcium chloride repeated according to blood results

Summary n n Cardiac arrest can have a variety of causes The chain of survival is essential to improve outcome from cardiac arrest