BASIC LIFE SUPPORT WITH THE USE OF AN AUTOMATED EXTERNAL

DEFIBRILLATOR (AED)

Shake gently
Check response
Ask loudly: Are you all right?

If unresponsive Open airway & check for breathing

If unresponsive and If breathing normally

not breathing normally

Turn into recovery position

ational emergency response number, send
someone to get
Call national an AED response number
emergency
Continue to assess that breathing remains normal

Start chest compressions

immediately
Place your hands in the centre of the chest
Deliver 30 chest compressions:
- Press rmly at least 5 cm but no more than 6 cm deep
- Press at a rate of at least 100/min but no more than 120/min
If trained and able combine chest compressions with ventilations otherwise continue w
- Seal your lips around the mouth
- Blow steadily until the chest rises
- Give next breath when the chest falls
Continue CPR 30 compressions to 2 ventilations

As soon as AED arrives

Follow the spoken/visual directions
Switch on the AED & attach pads
Attach one pad below the left armpit
Attach the other pad below the right collar bone, next to the breas
If more than one rescuer: do not interrupt CPR

Stand clear and deliver shock

If shock is indicated
Continue CPR

Follow AED instructions

Continue CPR unless you are certain the victim has recovered and starts to breathe normally.

Copied from European Resuscitation Guidelines 2015.

 ANAPHYLAXIS

Anaphylactic reaction?

Assess using ABCDE approach

Diagnosis - look for:

Acute onset of illness
Life-threatening Airway and/or
Breathing and/or Circulation problems1
And usually skin changes

Call for help

Lie patient flat with raised legs (if breathing allows)

Adrenaline2

When skills and equipment available:

Establish airway
Monitor:
High flow oxygen
Pulse oximetry
IV fluid challenge3
ECG
Chlorphenamine4
Blood pressure
Hydrocortisone5

1. Life-threatening problems:
Airway: swelling, hoarseness, stridor
Breathing: rapid breathing, wheeze, fatigue, cyanosis, SpO2 < 92%, confusion
Circulation: pale, clammy, low blood pressure, faintness, drowsy/coma

2. Adrenaline (give IM unless experienced with IV adrenaline)

IM doses of 1:1000 adrenaline (repeat after 5 min if no better)
Adult 500 mcg IM (0.5 mL)
Child more than 12 years 500 mcg IM (0.5 mL) 3. IV fluid challenge (crystalloid):
Child 6-12 years 300 mcg IM (0.3 mL) Adult 500 - 1000 mL
Child less than 6 years 150 mcg IM (0.15 mL)Child 20 mL kg-1
Stop IV colloid if this might be the cause of anaphylaxis

Adrenaline IV to be given only by experienced specialists

Titrate: Adults 50 mcg; Children 1 mcg kg-1

4. Chlorphenamine 5. Hydrocortis
(IM or slow IV) (IM or slow IV)
or child more than 12 years 10 mg 200 mg
6 - 12 years 5 mg 100 mg
6 months to 6 years 2.5 mg 50 mg
less than 6 months 250 mcg kg-1 25 mg
Copied from European Resuscitation Guidelines 2015.
 HYPERKALAEMIA

Assess using ABCDE approach

12-lead ECG and monitor cardiac rhythm if serum potassium (K+) 6.5 mmol L-1
Exclude pseudohyperkalaemia
Give empirical treatment for arrhythmia if hyperkalaemia suspected

MILD
MODERATE SEVERE
K+ 5.5 - 5.9 mmol L-1
K+ 6.0 - 6.4 mmol L-1 K+ 6.5 mmol L-1
Consider cause &
Treatment guided by clinical scenario, ECG andtreatment
Emergency rate of rise
indicated
need for treatment

Seek expert help

ECG changes?
Peaked T waves Broad QRS Bradycardia
Flat / absent P waves Sine wave VT

Protect the heart

IV calcium
10 mL 10 % calcium chloride IV
OR 30 mL 10 % calcium gluconate IV
Use large IV access and give over 5-10 min
Repeat ECG
Consider further dose after 5 min if ECG changes persist

Insulinglucose IV infusion
Shift K+ Glucose (25 g) with 10 units soluble insulin over 15 min IV
into 25 g glucose = 50 mL 50 % glucose OR 125 mL 20 % glucose
cells
Risk of hypoglycaemia
Salbutamol 10-20 mg nebulised

Consider
Remove K+ calcium resonium Consider dialysis
from body 15 g x 4/day oral or Seek expert help
30 g x 2/day per rectum

Monitor K+ & blood

Monitor serum potassium and blood glucose
K+ 6.5 mmol L-1 despite medical therapy
glucose

Prevention Consider cause of hyperkalaemia and prevent recurrence

Copied from European Resuscitation Guidelines 2015.

 TRAUMATIC CARDIAC ARREST

NO

YES

Copied from European Resuscitation Guidelines 2015.

 DROWNING

Unresponsive and
not breathing normally?

Shout for help and

call emergency services

Open airway

Give 5 rescue breaths / ventilations

supplemented with oxygen if possible

Signs of life?

Start CPR 30:2

Attach AED and

follow instructions

Copied from European Resuscitation Guidelines 2015.

 NEWBORN LIFE SUPPORT
(Antenatal counselling)
Team briefing and equipment check

Birth
Maintain Temperature

Dry the baby

Maintain normal temperature
Start the clock or note the time

Assess (tone), breathing and heart rate

At
If gasping or not breathing: All
Open the airway Times
Give 5 inflation breaths Ask:
Consider SpO2 ECG monitoring 60 s Do
You
Need
Re-assess Help?
If no increase in heart rate
look for chest movement

If chest not moving:

Recheck head position
Consider 2-person airway control
Acceptable
and other airway manoeuvres
pre-ductal SpO2
Repeat inflation breaths
2 min 60 %
SpO2 monitoring ECG monitoring
3 min 70 %
Look for a response
4 min 80 %
5 min 85 %
10 min 90 %

If no increase in heart rate

look for chest movement
(Guided by oximetry if available)

When the chest is moving:

If heart rate is not detectable
or very slow (< 60 min-1)
Start chest compressions
Increase oxygen

Coordinate compressions with PPV (3:1)

Reassess heart rate every 30 seconds

If heart rate is not detectable
or very slow (< 60 min-1)
consider venous access and drugs

Discuss with parents and debrief team

Copied from European Resuscitation Guidelines 2015.

PAEDIATRIC BASIC LIFE SUPPORT

Unresponsive?

Shout for help

Open airway

Not breathing normally?

5 rescue breaths

No signs of life?

15 chest compressions

2 rescue breaths
15 compressions

Call national
emergency number
after 1 minute of CPR

Copied from European Resuscitation Guidelines 2015.

 BASIC LIFE SUPPORT AND

AUTOMATED EXTERNAL DEFIBRILLATION (AED)

Unresponsive and
not breathing normally

Call Emergency Services

Give 30 chest compressions

Give 2 rescue breaths

Continue CPR 30:2

As soon as AED arrives -

switch it on and follow
instructions

Copied from European Resuscitation Guidelines 2015.

 IN-HOSPITAL RESUSCITATION

Collapsed/ sick patient

Shout for HELP and assess patient

No Signs of life Yes

Call resuscitation team Assess ABCDE

Recognise & treat
Oxygen, monitoring, IV access

CPR 30:2
with oxygen and
airway adjuncts

Call resuscitation team

if appropriate

Apply pads/monitor
Attempt defibrillation
if appropriate

Advanced Life Support

when resuscitation Handover to
team arrives resuscitation team

Copied from European Resuscitation Guidelines 2015.

 AVALANCHE ACCIDENT

Assess patient at extrication

Lethal injuries or YES Do not

Whole body start CPR
frozen

NO

Duration of burial 60 min ( 30C)

Universal ALS
(core algorithm2
temperature)1
> 60 min (< 30C)
YES
Signs of life?3 Minimally invasive
rewarming4

NO
VF/pVT/PEA
Start CPR5 VF/pVT/PEA
Monitor ECG

Asystole

Patent airway YES/ UNCERTAIN

Consider serum Hospital
potassium6 with ECLS

NO > 8 mmol L -1
Consider termination
of CPR
1. Core temperature may substitute if duration of burial is unknown
2. Transport patients with injuries or potential complications (e.g. pulmonary
oedema) to the most appropriate hospital
3. Check for spontaneous breathing and pulse for up to 1 min
4. Transport patients with cardiovascular instability or core temperature < 28C
to a hospital with ECLS (extracorporeal life support)
5. Withold CPR if risk to the rescue team is unacceptably high
Crush injuries and depolarising neuromuscular blocking drugs may elevate .6
serum potassium

Copied from European Resuscitation Guidelines 2015.

 ADVANCED LIFE SUPPORT

Unresponsive and
not breathing normally?

Call Resuscitation
Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions

Assess rhythm

Non- Shockable
shockable (VF/Pulseless
(PEA/Asystole VT)

Return of
Spontaneous 1 Shock
circulation Minimise
interruptions
IMMEDIATE POST
CARDIAC
ARREST TREATMENT
Immediately resume Use ABCDE approach
Immediately
CPR for 2 min Aim for SaO2 of 94-98% resume
Minimise Aim for normal PaCO2 CPR for 2 min
Interruptions 12 Lead ECG Minimise
Treat precipitating cause
TREAT REVERSIBLE
CAUSES
Targeted temperature
management Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/
metabolic
Hypothermia/hypertherm
DURING CPR
ia
Ensure high quality chest
Thrombosis coronary or
compressions
pulmonary
Minimise interruptions to
Tension pneumothorax
compressions
Tamponade
Give oxygen
cardiac

CONSIDER Use waveform capnography

Ultrasound imaging Continuous compressions when
Mechanical chest compressions to facilitate advanced airway in place
transfer/treatment Vascular access (intravenous or
Coronary angiography and percutaneous intraosseous)
coronary intervention Give adrenaline every 3-5 min
Extracorporeal CPR Give amiodarone after 3 shocks

Copied from European Resuscitation Guidelines 2015.