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resuscitation
council
Summary
of the main
changes in the
Resuscitation
Guidelines
ERC Guidelines 2010
2
European
Resuscitation
Council
To p r e s e r v e h u m a n l i f e b y m a k i n g
high quality resuscitation available to all
The Network of National Resuscitation Councils
Published by:
European Resuscitation Council Secretariat vzw,
Drie Eikenstraat 661 - BE 2650 Edegem - Belgium
Website: www.erc.edu
Email: info@erc.edu
Tel: +32 3 826 93 21
©
European Resuscitation Council 2010.
All rights reserved. We encourage you to send this document to
other persons as a whole in order to disseminate the ERC Guidelines.
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purposes, without the prior written permission of the ERC.
Version1.2
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a matter of products liability, negligence or otherwise, or from any
use or operation of any methods, products, instructions or ideas
contained in the material herein.
3
UNRESPONSIVE?
Open airway
Call 112*
30 chest compressions
2 rescue breaths
30 compressions
Unresponsive?
Open airway
Not breathing normally
AED
assesses
rhythm
Shock No shock
advised advised
1 Shock
Call
Resuscitation Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock spontaneous
circulation
Broad Narrow
• Amiodarone 300 mg IV over
10-20 min and repeat shock;
followed by:
• Amiodarone 900 mg over 24 h
prophylaxis
10
Bradycardia
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO2 ,record 12 lead ECG
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Atropine
500 mcg IV
Satisfactory
Yes
Response?
No Risk of asystole?
• Recent asystole
Yes • Möbitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s
Interim measures:
* Alternatives include:
• Aminophylline
• Dopamine
• Glucagon (if beta-blocker or calcium channel
blocker overdose)
• Glycopyrrolate can be used instead of atropine
11
♦♦ When treating VF/VT cardiac arrest, ♦♦ Much greater detail and emphasis
adrenaline 1 mg is given after the third on the treatment of the post-cardiac
shock once chest compressions have arrest syndrome.
restarted and then every 3-5 min-
utes (during alternate cycles of CPR).
Amiodarone 300 mg is also given after ♦♦ Recognition that implementation
the third shock. of a comprehensive, structured post
resuscitation treatment protocol may
improve survival in cardiac arrest vic-
♦♦ Atropine is no longer recommend- tims after ROSC.
ed for routine use in asystole or pulse-
less electrical activity (PEA).
♦♦ Increased emphasis on the use
of primary percutaneous coronary
♦♦ Reduced emphasis on early tra- intervention in appropriate (includ-
cheal intubation unless achieved by ing comatose) patients with sustained
highly skilled individuals with minimal ROSC after cardiac arrest.
interruption to chest compressions.
ACS
Patient with clinical signs and symptoms of ACS
12 lead ECG
ST elevation
≥ 0.1 mV in ≥ 2 adjacent limb leads and/ Other ECG alterations
or ≥ 0.2 mV in ≥ adjacent chest leads (or normal ECG)
or (presumably) new LBBB
STEMI
non-STEMI-ACS
High risk
• dynamic ECG changes
• ST depression
• haemodynamic/rhythm instability
• diabetes mellitus
ECG
ECG
STEMI Non-STEMI-ACS
UNRESPONSIVE?
Open airway
5 rescue breaths
NO SIGNS OF LIFE?
15 chest compressions
2 rescue breaths
15 compressions
Unresponsive?
Not breathing or only occasional gasps
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock 4 J/Kg spontaneous
circulation
Re-assess
If no increase in heart rate
Look for chest movement
Acceptable*
If chest not moving
pre-ductal SpO2
Recheck head position
Consider two-person airway control 2 min : 60%
or other airway manoeuvres 3 min : 70%
Repeat inflation breaths 4 min : 80%
Consider SpO2 monitoring
5 min : 85%
Look for a response
10 min : 90%
Authors
These benefits add to all the benefits you experienced as a web member:
IMPORTANT
ERC currently offers combined membership possibilities with a number of
organisations, with an additional discount: Belgian Resuscitation Council,
Norwegian Resuscitation Council, Resuscitation Council UK.
If you are already a member of one of these organisations, please contact
their secretariat for additional information about combined membership
possibilities.
www.erc.edu
www.CPRguidelines.eu