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    ACLS Power Point

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    nishith
    This document provides guidelines for performing cardiopulmonary resuscitation (CPR) and advanced life support for patients with suspected or confirmed COVID-19. It discusses reducing exposure risk by using proper personal protective equipment and limiting the number of rescuers. It also provides recommendations to limit aerosol generation during resuscitation, such as performing hands-only CPR when possible and using equipment like bag mask devices with filters.

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    ACLS Power Point

    Uploaded by

    nishith
    523 views28 pages
    This document provides guidelines for performing cardiopulmonary resuscitation (CPR) and advanced life support for patients with suspected or confirmed COVID-19. It discusses reducing exposure risk by using proper personal protective equipment and limiting the number of rescuers. It also provides recommendations to limit aerosol generation during resuscitation, such as performing hands-only CPR when possible and using equipment like bag mask devices with filters.

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    This document provides guidelines for performing cardiopulmonary resuscitation (CPR) and advanced life support for patients with suspected or confirmed COVID-19. It discusses reducing exposure risk by using proper personal protective equipment and limiting the number of rescuers. It also provides recommendations to limit aerosol generation during resuscitation, such as performing hands-only CPR when possible and using equipment like bag mask devices with filters.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    523 views28 pages

    ACLS Power Point

    Uploaded by

    nishith
    This document provides guidelines for performing cardiopulmonary resuscitation (CPR) and advanced life support for patients with suspected or confirmed COVID-19. It discusses reducing exposure risk by using proper personal protective equipment and limiting the number of rescuers. It also provides recommendations to limit aerosol generation during resuscitation, such as performing hands-only CPR when possible and using equipment like bag mask devices with filters.

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    Dr Nishith Govil Dr Kumar Parag

    BLS assessment
    • Check responsiveness

    • Shout for help

    • Activate ERS

    • Get AED/ Defibrillator

    • Check breathing and Pulse

    • Defibrillate/ high Quality CPR


    Primary Assessment

    • Airway

    • Breathing

    • Circulation

    • Disability

    • Exposure
    Airway

    • Patency: HTCL, OA, NPA

    • Advance airway: LMA, ETT

    • Synchronization of Compression and ventilation

    • Confirmation of proper placement

    • Secure

    • Monitoring with continuous quantitative waveform capnography


    Breathing

    • Monitor with oxyhemoglobin saturation

    • Administer 100 % oxygen

    • Target SpO2 94 % or greater

    • Avoid excessive ventilation

    • 10 breaths per minute for adults

    • 20 - 30 breaths per minute for pediatric


    Circulation

    • Attach Monitor for rhythm analysis

    • Provide Defibrillation as per rhythm analysis

    • Obtain IV/IO access

    • Give fluid if needed

    • Use appropriate Drugs

    • Check Glucose and Temperature


    Disability and Exposure

    • Check for neurological function

    • Responsiveness : alert, Voice, Pain, Unresponsiveness

    • Level of consciousness

    • Pupil Dilatation

    • Physical examination for obvious cause of arrest


    Secondary Assessment
    High Quality CPR
    • Push Hard (2 inches or 5 cm)
    • Push fast (100 -120 / min)
    • Minimize interruptions to < 10 sec
    • Avoid excessive ventilation
    • Allow chest recoil
    • Target PETCO2 > 10 mm Hg
    • Target diastolic pressure > 20 mm Hg (intraarterial pressure)
    Defibrillation
    • High energy unsynchronized shocks
    • 120 – 200 J biphasic
    • Manual defibrillator preferred over AED
    • Stunning of heart
    • Caution for oxygen flowing over the chest
    • Use sedation
    • SVT/ Atrial Flutter 50J, Mono VT 100J, AF 200J
    Drugs in ACLS

    • Epinephrine 1 mg every 3 – 5 minutes

    • Amiodarone 300 mg Ist dose; 150 mg 2nd Dose

    • Atropine 0.5mg bolus every 3-5 min, max 3 mg

    • Dopamine 2-20 mcg/kg/min

    • Epinephrine 2-20 mcg/min

    • Adenosine 6 mg bolus f/b 12 mg if required


    ROSC
    • Titrate Spo2 to 92-98%
    • PaCO2 35-45 mm Hg
    • SBP > 90 mm Hg
    • MAP > 65 mm Hg
    • Use fluid and inotropes
    • Lung protective ventilation
    • TTH 32-36 degree C for 24 hour
    Multimodal Neuroprognostication

    • 12 lead ECG; cardiac intervention if STEMI

    • Normoxia, normocapnia, euglycemia if awake

    • TTM, Brain CT, upto 24 hour if comatose

    • After 24 hour upto 72 hour; MRI, EEG, serum NSE, rewarming

    • Prognostication done 72 hour after normothermia and limiting


    sedation
    CPR (BLS) in COVID patients
    • Interim Guidance for Basic and Advanced Life Support in Adults,
    Children, and Neonates With Suspected or Confirmed COVID-19

    • Circulation. 2020;141:e933–e943.
    DOI:10.1161/CIRCULATIONAHA.120.047463
    Dana P. Edelson. Circulation. Interim Guidance for Basic and
    Advanced Life Support in Adults, Children, and Neonates With
    Suspected or Confirmed COVID-19, Volume: 141, Issue: 25,
    Pages: e933-e943, DOI:
    (10.1161/CIRCULATIONAHA.120.047463) © 2020 American Heart Association, Inc.
    Reduce exposure

    • Move to a negative pressure room

    • Close the door

    • Don PPE

    • Reduce personnel

    • Consider Mechanical CPR device

    • Communicate COVID status


    Limit Aerosolization
    • Perform at least Hands only CPR

    • Cover face and nose with a cloth

    • Passive oxygenation with nonrebreathing face mask

    • Bag and Mask device with tight seal and hepa filter

    • Intubate early by an experienced intubator

    • Minimise close circuit disconnection

    • Use close suction catheter

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