IMMEDIATE LIFE SUPPORT -ILS

MODULAR COURSE
TH - Anuradhapura
Department of Anaesthesia TH Anuradhapura

In collaboration with College of Anaesthesiologists &

Intensivists of Sri Lanka
Advanced Life Support

Learning outcomes Basic Life Support- BLS

• The BLS/ALS algorithm
• Treatment of shockable and non-shockable
rhythms
• Potentially reversible causes of cardiac arrest
• Role of resuscitation team

Cardiac Arrest Free from Dangers

exposed electrical wire, falling PPE
items, fire, leaked fuel & gas

•Unresponsive and not ( Wear gloves, mask,

apron)
breathing normally are the
indicators for commencement
of resuscitation Ensure safety of rescuer and
(chest compressions) victim
 Evaluate Responsiveness OPENING THE AIRWAY
 Check responsiveness
“Hello! Hello! Are
 tap/shake shoulders
you Ok?” gently
 call out loud

If responsive
Leave him in the position in which you find
him provided there is no further danger
Head tilt , Chin lift
If cervical spine injury suspected:
Call for Help jaw thrust

www.cmft.nhs.uk/undergrad

CARDIAC ARREST CONFIRMED

CHECK FOR BREATHING
Send /Call for Help

• Look for chest movement

• Listen for breath sounds
• Feel for expired air on your
cheek
At the same time feel for
the carotid pulse
( only for HCP)
[Spend < 10 seconds]

Start CPR- circulate oxygen Continue CPR

30 CHEST COMPRESSIONS

• Heel of hands - lower half of

the sternum

• Push hard - compress 5 – 6 cm 30 : 2

1-person or 2-person CPR

• Push fast - 100 - 120 / min < 5 sec for 2 breaths

If more than one rescuer is
present, change rescuer
• Allow chest to recoil every 2 mins
Continue CPR until defibrillator is
available.

Advanced Life Support

ALS algorithm- Shockable

Analyse Analyse
Rhythm Rhythm
Shockable Non- shockable Shockable
VF/Puleless VT Asystole/PEA VF/Puleless VT
Return of
1 shock spontaneous
150 -200 J biphasic circulation
360J monophasic
• VF
Immediate post arrest – Bizzare, irregular
Immediately resume treatment Immediately resume
CPR 30:2 for 2 min • Assess using ABCDE CPR 30:2 for 2 min
Minimise interruptions approach Minimise interruptions
Push drugs • Control oxygenation and Push drugs • Pulseless VT
when indicated ventilation when indicated
• 12-lead ECG – Rapid, regular, broad
• Treat precipitating QRS
Adrenaline 1mg & causes
Amiodarone 300mg IV/IO • Temperature control / Adrenaline 1mg (IV/IO) as
after 3rd shock then repeat soon as access obtained and
therapeutic hypothermia
adrenaline after every then every alternate loop
alternate shock

Deliver shock Restart CPR

Analyse
Rhythm • After the shock- immediately resume CPR
Shockable
VF/Puleless VT
• While the defibrillator is charging for 2 min
on the machine “ continue CPR
1 st shock
200 joules
Oxygen away & do safety check” • Check rhythm only after 2 min CPR !
• Once the defibrillator is charged
• “stand clear “ • Minimise interruptions to CPR
Discharge the shock and return the
paddles to the machine • Keep eye on ET CO2 ( > 14 mmHg)
150 J First shock ,
270 J 2nd & subsequent shocks
• ( Pre shock Pause < 5 sec)
 During CPR ( in between rhythm checks) If VF / VT persists
 Ensure high-quality CPR: rate, depth, recoil
Deliver 2nd shock
 Plan actions before interrupting CPR
 Continuous chest compressions when
CPR for 2 min
advanced airway in place ( LMA, ETT)
 Once airway secured, do not interrupt
chest compressions for ventilation Deliver 3rd shock

 Vascular access (IV/ IO)

so breaths Imig
CPR for 2 min
 Give drugs as indicated. During CPR 10mL
Adrenaline 1 mg IV ← Dilute in

Amiodarone 300 mg IV bolus I .

'

10000

to
flush with NS

Non-shockable Drugs
Analyse Analyse
Rhythm Rhythm
Non- shockable Non- shockable
Asystole/PEA Asystole/PEA
c-
As soon as IV /IO access
• Asystole available
c) – No electrical activity • Adrenaline 1mg l -
: 10000

– Occasionally P waves Immediately resume

electrical CPR 30:2 for 2 min
• PEA ( Dulse less • Repeat every alternate Minimise interruptions
actions)
– Any perusing rhythm cycle ( q- 3-5 min) Push drugs
when indicated
with no pulse

give adrenalin 1 : 10000

µ

After 2min CPR Correct reversible causes

Analyse
Rhythm warm Iv fluid
Non- shockable ←

Asystole/PEA
• Analyse rhythm
• If still non-shockable
then repeat the process
c- fluid / Blood
• If shockable then go to Immediately resume
CPR 30:2 for 2 min ← thora co
shockable side of Minimise interruptions
sente er ,

algorithm Push drugs

needle
when indicated thoracotomy
• Check pulse if ECG Ic tube

Rhythm is – perfusing..
← Antidote
 Pulmonary embolism Hyperkalemic – cardiac arrest
• consider giving a thrombolytic drug • Protect the heart first: give 10 ml of 10% Ca
immediately if PE is suspected Gluconate by rapid bolus injection.

• Thrombolytic drugs may take up to 90 min to

be effective; only administer if it is
appropriate to continue CPR for this
duration.

Hypokalemia < 3.5 mmol/l Maternal Cardiac Arrest

• Severe hypokalaemia – K+ < 2.5 mmol /l • Call for help early
(Anaesthetist, VOG &
and may be associated with symptoms. neonatologist).
• Remove caval compression
(after 20/40 POA )
• KCL 20 mmol /10 min, followed by 10 mmol / 10
min) is indicated for unstable arrhythmias when
cardiac arrest is imminent or in cardiac arrest .

Left uterine displacement with 2- Left uterine displacement using 1-

handed technique handed technique
Patient in a 15-30° left-lateral tilt Drowning –ALS modifications
• Prompt initiation of recue breathing
Give 5 initial breaths
• Early tracheal intubation/IPPV
• PEEP at least 10 cmH2O ( May need 15-20 cmH2O )

• Dry chest before defibrillation

• IV fluids.

ROSC Post resuscitation care

• If organised electrical activity compatible with a
cardiac output is seen during a rhythm check, • ABCDE assessment. Stabilise the patient .
• Check a central pulse and end-tidal CO2 trace • Definitive airway – ETT
• If there is evidence of ROSC, start post-resuscitation • CXR,ABG, 12 lead ECG, ECHO.
care. • Talk to cardiac team.
• If no signs of ROSC, continue CPR
• ICU care. ( Targeted Temperature Management )
• Team debriefing , complete notes, talk to
relatives.

Questions? Summary

• Importance of early high quality chest

compressions
• Early defibrillation if indicated.
• Correct reversible causes of cardiac arrest
• Post resuscitation care