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Resus 2010
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Adult Resuscitation

BLS

CPR No Minimum 100 and no greater than 120 compressions per minute

VENTILATION


Ventilation 1 second and not 2


Oxygen – initially not required (unless hypoxia is primary cause of arrest). Attach O2 when no interruption in CPR will be possible.


DEFIBRILLATION


Pause of no longer than 5 seconds between sets of chest compressions

Defib as soon as possible (do not do 2 minutes of CPR when you first arrive)

Continue compressions while charging

As soon as defib is charged quick look to confirm and deliver shock (no more than 5 seconds off compressions). Note this is not possible with the Zoll AED Pro as the rescuer must be “off chest” for analysis.

The person doing the compressions must be the same person who delivers the shock for H&S reasons

Precordial thump is indicated if witness AND monitored arrest

INTUBATION

All ETT should be stored and used uncut (tape is not suitable to hold tubes uncut in position)

DRUGS

Shockable Algorithm (VF/pulseless VT):
• Adrenaline 1:10,000 (1mg) should be administered once chest compressions have been restarted after the delivery of the 3rd shock and then repeated every 3-5 minutes post alternate shocks.
• Amiodarone (300mg) should be administered after the third shock (post adrenaline) in refractory VF/VT. A further dose of 150mg may be given if the patient remains in VF/VT after the 5th shock.

Non-shockable Algorithm
Non-shockable side of algorithm (asystole/PEA)
• Adrenaline 1:10,000 (1mg) is to be administered for asystole and PEA as soon as IV access is achieved, and repeated every 3-5 minutes whilst the patient remains in cardiac arrest.
• Atropine has been removed from the Asystole and PEA algorithm

Flushing Drugs
• All drugs injected peripherally (including external jugular) must be flushed with at least 20mls of Sodium Chloride (NaCl) 0.9%. A bag of fluid with 3 way tape is best way to achieve this.

Drug Routes
Endotracheal route is no longer indicated
If IV access is not gained with 2 minutes IO access should be sought.

Below is an Example of how an adult VF arrest could be run – this is only one approach that could be adopted – there are many other ways to do this.

Technician Paramedic
CPR til defib on Defib On
Get BVM out Attach Defib
Attach O2 Charge / CPR
Defibrillate
SWAP
CPR 2 minutes Ventilate
Reassess VF Prepare IV/IO
Charge / CPR Insert IV/IO
Defibrillate Secure / glucose
SWAP
Vnetilate CPR 2 minutes
Prepare Epi/Ami ? Glucose (BM)
Calculate Epi/Ami
Charge / CPR
Defibrillate
SWAP
CPR 2 minutes Ventilate
Charge / CPR Give Epi/Ami
Defibrillate Saline 10ml/kg

SWAP
Ventilate CPR 2 minutes
LMA Charge / CPR
Prepare Epi/Ami Defibrillate
SWAP
CPR 2 minutes Ventilate
Charge / CPR Give Epi/Ami -1/2
Defibrillate 4Hs & 4Ts
SWAP
Ventilate CPR 2 minutes
Treat (4Hs & 4Ts)
Prepare Epi Charge / CPR
Defibrillate
SWAP
CPR 2 minutes Ventilate
Charge / CPR Give Epi
Defibrillate















 

 


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