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    ATLS

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    alice Dillerud
    This document discusses pediatric advanced cardiac life support (PALS) algorithms. It describes the differences between shockable and non-shockable cardiac rhythms in children and the appropriate treatment for each. For non-shockable rhythms like asystole and pulseless electrical activity, the algorithm calls for immediate chest compressions, oxygen administration, and adrenaline every 3-5 minutes. For shockable rhythms like ventricular fibrillation, the recommended treatment includes defibrillation at 4 J/kg followed by chest compressions and adrenaline after the third shock. The document also reviews reversible causes of cardiac arrest and the roles of resuscitation team members.

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    ATLS

    Uploaded by

    alice Dillerud
    60 views34 pages
    This document discusses pediatric advanced cardiac life support (PALS) algorithms. It describes the differences between shockable and non-shockable cardiac rhythms in children and the appropriate treatment for each. For non-shockable rhythms like asystole and pulseless electrical activity, the algorithm calls for immediate chest compressions, oxygen administration, and adrenaline every 3-5 minutes. For shockable rhythms like ventricular fibrillation, the recommended treatment includes defibrillation at 4 J/kg followed by chest compressions and adrenaline after the third shock. The document also reviews reversible causes of cardiac arrest and the roles of resuscitation team members.

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    This document discusses pediatric advanced cardiac life support (PALS) algorithms. It describes the differences between shockable and non-shockable cardiac rhythms in children and the appropriate treatment for each. For non-shockable rhythms like asystole and pulseless electrical activity, the algorithm calls for immediate chest compressions, oxygen administration, and adrenaline every 3-5 minutes. For shockable rhythms like ventricular fibrillation, the recommended treatment includes defibrillation at 4 J/kg followed by chest compressions and adrenaline after the third shock. The document also reviews reversible causes of cardiac arrest and the roles of resuscitation team members.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    60 views34 pages

    ATLS

    Uploaded by

    alice Dillerud
    This document discusses pediatric advanced cardiac life support (PALS) algorithms. It describes the differences between shockable and non-shockable cardiac rhythms in children and the appropriate treatment for each. For non-shockable rhythms like asystole and pulseless electrical activity, the algorithm calls for immediate chest compressions, oxygen administration, and adrenaline every 3-5 minutes. For shockable rhythms like ventricular fibrillation, the recommended treatment includes defibrillation at 4 J/kg followed by chest compressions and adrenaline after the third shock. The document also reviews reversible causes of cardiac arrest and the roles of resuscitation team members.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 34

    Advanced cardiac life support

    Group : Aden, Eichman, Lucy, Jackie, Victor

    Presenter: Alice
    ACLS: include
    • Endotrachel intubation.
    • Electrical defibrillation
    • Pharmacologcal intervention
    Causes of cardiac arrest
    Hs and Ts
    • Hypovolaemia
    • Hypoxia
    • Hypothermia
    • Hypo/hyperkalemia
    • H+ ion(acidosis)
    • Toxins, tamponade, trauma
    • Tension pneumothorax, throbosis(coronary/PE
    Paediatric
    ALS algorithm
    Paediatric ALS algorithm

    Assess responsiveness and ABC


    Immediately start CPR ensuring high
    concentration of oxygen is being used with
    BMV
    Continue resuscitation while waiting on arrival
    of resuscitation team
    Attach monitor as soon as available ensure
    correct placement of electrodes / pads -
    rhythm can be monitored through ECG leads /
    adhesive pads and paddles
    Paediatric ALS algorithm

    Assess rythm – shockable or non- shockable.


    Non-shockable rhythms most likely in
    paediatric age group so will look at
    management of these first.
    Pulse palpation for 10 seconds cannot give a
    reliable measurement of the presence or
    absence of an effective circulation. The
    presence or absence of signs of life should also
    be use e.g. response to stimuli, normal
    breathing or spontaneous movement
    Non-shockable (PEA / Asystole)
    Non-Shockable

    Asystole
    Asystole – check patient, check leads (I, II, III),
    check gain, check electrodes. It is rarely a
    straight line
    Non-shockable (PEA / Asystole)
    Non-Shockable

    Pulseless electrical activity (PEA)

    PEA – a clinical state characterised by organised electrical activity in


    the absence of palpable pulse
    QRS complex could be wide or narrow, slow or fast
    Assess
    Non-shockable algorithm
    rhythm
    Non-Shockable
    (PEA / Asystole)

    Immediately resume
    CPR for 2 min
    Adrenaline Minimise interruptions
    10 mcg kg-1 as soon as IV access
    is obtained and then
    every second loop or
    every 3 - 5 mins

    On diagnosis of rhythm, immediately resume CPR


    Adrenaline can be given as soon as vascular access is obtained and
    then every other loop in the algorithm
    Pause briefly at the end of the two minute cycle to confirm rhythm on
    monitor
    Continue with 2 minute cycles
    During any cardiorespiratory arrest, continually seek and treat 4 H’s
    and 4 T’s
    Shockable (VF / Pulseless VT)
    Shockable

    Ventricular fibrillation (VF)


    Chaotic, disorganised series of depolarisations
    Shockable rhythms can occur in 27% of in-hospital cardiorespiratory
    arrests in children often as a reperfusion rhythm, its incidence being
    highest in children over 8 years and in the under 1 year age group.
    Suspect in child with underlying cardiac disease, history of ingestion of
    drugs
    Shockable

    Shockable(VF / Pulseless VT)

    Pulseless ventricular tachycardia (VT)


    Uncommon in children
    Child may have underlying heart disease (post
    cardiac surgery, cardiomyopathy, myocarditis,
    electrolyte disturbances, prolonged Q-T
    interval)
    Drug ingestion
    Shockable algorithm
    A DC shock of 4J/kg should be administered as soon as
    defibrillator available
    Immediately resume 2 minute cycle of CPR without rhythm
    check Assess
    If not already, obtain vascular access rhythm
    Brief pause at end of CPR cycle to confirm rhythm followed
    by further DC shock at 4J/kg
    Adrenaline given immediately after the 3rd shock and given
    every second loop thereafter
    Amiodarone should be given immediately after the 3rd shock Shockable
    and repeated after the 5th shock if VF/pulseless VT persists
    Continue in 2 minute cycles (VF / Pulseless VT)
    Continually seek and treat reversible causes!

    1 Shock
    4J / kg
    Adrenaline
    10 mcg kg-1
    after the 3rd shock
    and then every 3 - 5 mins Immediately resume
    CPR for 2 min
    Amiodarone Minimise interruptions
    5 mg kg-1
    after the 3rd and 5th shocks
    During CPR/ Reversible causes
    ROSC
    Resuscitation team

    • Roles should be planned in advance


    • Identify team leader
    • Plan interruptions to minimise breaks in chest
    compressions
    Team members
    (TM6)
    (TM1)
    Parents
    Airway /Ventilation

    (TM3)
    (TM2) Defibrillation
    Chest compressions/pulse

    (TM4)
    IV access/drugs (TM5)
    Scriber/drugs

    (TL) Team Leader


    Summary

    • PALS algorithm
    • Non-shockable and shockable rhythms
    • Potentially reversible causes
    • Administration of drugs during
    cardiorespiratory arrest
    • Role of the resuscitation team
    ADULT ATLS
    • Intubation : will give swift control of airway
    with minimal interruptions in chest
    compressions and no delay in defibrillation.
    • Optimize oxygenation and removal of co2.
    • Drugs given in ETT: naloxone,atropin,
    vasopressin, epinephrine and lidocaine)
    NAVEL
    TO SHOCK OR NOT ?
    SHOCKABLE RHYTHMS DO NOT SHOCK

    • Ventricular fibrillation • Asystole

    • Ventricular tachycardia( • Pulseless electrical


    no pulse) activity
    defibrillation
    • 1 shock, continue CPR while charging
    • Biphasic-manual ( 120-200)J
    • Monophasic: 360 J
    • Resume CPR immediately after shock
    • Drugs: Epi 1mg q 3-5 minutes. 1 dose of vasopressin 40 iu(controversial)
    btn 1st and 2nd dose of Epi.
    • Antiarrythimics :amiadarone 300mg rpt150mg once or lidocaine 1-
    1.5mg/kg stat then 0.5-0.75 mg/kg q 5-10min max 3mg/kg.
    • Magnesium: 1-2 g IV if torsades de pointes
    REVERSIBLE CAUSES
    • Hypovolemia • Tension pneumothorax
    • Hypoxia • Tamponade ( cardiac)
    • Hydrogen ion ( acidosis) • Toxins
    • Hypo/ hyperkalaemia • Thrombosis
    • hypothermia (pulmonary)
    • Thrombosis (coronary)
    How long?
    When do you stop CPR?
    • AED available and ready to use
    • Obvious signs of life
    • Another trained personnel takes over
    • Scene becomes unsafe
    • Obvious death-decapitation, rigor mortis
    • Physical fatigue.
    • More than 30 minutes without signs of life-toddler revived after 1hr 41 minutes.
    AHA.younger the patient the longer the resuscitation time

    • AED-automated external defibrillator.


    POST ARREST CARE
    • After ROSC
    • Multidisciplinary

    • Neuroprotection
    – ventilation
    – Sedation
    – Temperature control
    – Glucose control
    Post arrest care

    • sedation

    • Temperature control
    – Targeted temperature control

    • Glucose control
    – Maintain blood glucose ≤ 10mmol/l (180mg/dl)
    – Avoid hypoglycemia
    •Thank you

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