ADVANCED LIFE SUPPORT

Cardiology Service of Hospital San Juan de Dios de La Plata Leonardo F. Mancini

Advanced CPR
I - PRIMARY ABCD A - B Open air - Ventilation: Positive pressure ventilation - C
Circulation: chest compressions D - Defibrillation unit: automatic or semiautom
atic
II - SECONDARY ABCD A - Airway: endotracheal intubation B - Ventilation: oxygen
C - Circulation: EV-way - identify rhythm - appropriate drug D - Differential Di
agnosis: search and treat reversible causes
PCR
â ¢ Forms of presentation:
1) VF / pulseless VT 2) Non VF / VT: PEA Asystole
VF / pulseless VT
Active Response Rate missing SEM primary ABCD basic CPR and defibrillation defib
rillator Ask A - Airway B - Ventilation: 2 ventilations C - D Perform 15 chest c
ompressions - defibrillator: evaluating FV / TV (200 - 200/300 - 360 J) Rhythm a
fter 3 downloads FV / TV persistent or recurrent secondary ABCD A - Intubate as
soon as possible B - B Confirm tube placement - Secure the ETT B - Confirm effec
tive oxygenation and ventilation C - Estabezca via EV D - Differential Diagnosis
: search and Epinephrine causes associated question 1 mg / 3-5 min single dose V
asopressin 40 U defibrillator after 30-60 sec with 360 J defibrillation after 30
-60 sec with 360 J
Dallas 2000 - AHA
Antiarrhythmics Amiodarone (II b) Lidocaine (indeterminate)
Consider Magnesium Buffers
VF / pulseless VT
Active Response Rate missing SEM primary ABCD quality basic CPR and defibrillati
on defibrillator Ask A - Airway B - Ventilation: 2 ventilations C - D Perform 30
chest compressions - defibrillator: evaluating FV / TV 360 J (monophasic wavefo
rm) and 120 - 200 J (biphasic) CPR between shocks (5 cycles = 2 min) FV / TV per
sistent or recurrent secondary ABCD A - Intubate as soon as possible B - B Confi
rm tube placement - Secure the ETT B - Confirm effective oxygenation and ventila
tion C - Estabezca via EV D - Differential Diagnosis: search and try to causes a
ssociated with Epinephrine 1 mg / 3-5 min single dose Vasopressin 40 U defibrill
ator after 30-60 sec with 360 J defibrillation after 30-60 sec with 360 J
2005 Guidelines for CPR - AHA
Antiarrhythmics Amiodarone (II b) Lidocaine (indeterminate)
Consider Magnesium Buffers
Defibrillation
Clinical benefits of biphasic: â ¢ Efficacy equivalent to monophasic waveform, wit
h no significant change in baseline dysfunction ST â ¢ Less post - Download â ¢ Less
power with less arrhythmia post - Download â ¢ Evidence of improved performance w
ith antiarrhythmic drugs â ¢ Evidence better performance with long-term PV
Asystole
ABC ABCD Focus on basic primary and defibrillation - Evaluate non-response - Act
ivate the SEM - Ask defibrillator A - Airway: open airway B - Ventilation: posit
ive pressure ventilation C - Start chest compressions C - Confirm asystole D - d
efibrillator: Evaluate VF / VT (200 - 200/300 - 360 J) * The 5 H: Hypothermia Hy
poxia Hypovolemia Hyper / hypokalemia hydrogen ions (acidosis) The 5 T: Tablets
(drug) Coronary Thrombosis Cardiac tamponade Tension (pneumothorax) PTE secondar
y ABCD A - Intubate as soon as possible B - B Confirm tube placement - Secure th
e ETT B - Confirm effective oxygenation and ventilation C - Estabezca via EV C -
Identify rhythm monitor C - Medications appropriate for rhythm and condition D
- Differential Diagnosis: search and try reversible causes Epinephrine 1 mg EV c
/ 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum dos
e: 0.04 mg / kg MCP transitory use it immediately if you have persistence of asy
stole: continue or discontinue CPR ?
Dallas 2000 - AHA
Asystole
Primary ABCD ABC Focus on basic quality and defibrillation - Evaluate non-respon
se - Activate the SEM - Order defibrillator A - Airway: open airway B - Ventilat
ion: positive pressure ventilation C - Start chest compressions C - Confirm asys
tole D - defibrillators : assess FV / TV (360 J) * The 5 M: Hypoxia Hypovolemia
hypothermia Hyper / hypokalemia hydrogen ions (acidosis) The 5 T: Tablets (drug)
Coronary Thrombosis Cardiac tamponade Tension (pneumothorax) PTE secondary ABCD
A - Intubate as soon as possible B - B Confirm tube placement - Secure the ETT
B - Confirm effective oxygenation and ventilation (CO2) C - Estabezca via EV C -
Identify rhythm monitor C - Medications appropriate for rhythm and condition D
- Differential Diagnosis: search and treat causes Epinephrine 1 mg EV reversible
w / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum d
ose: 3 mg Persistence of asystole: continue or stop CPR?
AHA - ACC 2005
AESP
ABC ABCD Focus on basic primary and defibrillation - Evaluate non-response - Act
ivate the SEM - Ask defibrillator A - Airway: open airway B - Ventilation: posit
ive pressure ventilation C - D Begin chest compressions - defibrillator: evaluat
ing FV / TV ( 200 - 200/300 - 360 J)
* The 5 H: Hypothermia Hypoxia Hypovolemia Hyper / hypokalemia hydrogen ions (ac
idosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (p
neumothorax) TEP
Secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - S
ecure the ETT B - Confirm effective oxygenation and ventilation C - Estabezca vi
a EV C - Identify rhythm monitor C - Medications appropriate for rhythm and cond
ition * D - Differential Diagnosis: search for and treat reversible causes Epine
phrine 1 mg EV c / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5
min Maximum dose: 0.04 mg / kg
Dallas 2000 - AHA
AESP
Primary ABCD ABC Focus on basic quality and defibrillation - Evaluate non-respon
se - Activate the SEM - Ask defibrillator A - Airway: open airway B - Ventilatio
n: positive pressure ventilation C - D Begin chest compressions - defibrillator:
evaluating FV / TV (360 J)
* The 5 H: Hypothermia Hypoxia Hypovolemia Hyper / hypokalemia hydrogen ions (ac
idosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (p
neumothorax) TEP
Secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - S
ecure the ETT B - Confirm effective oxygenation and ventilation C - Estabezca vi
a EV C - Identify rhythm monitor C - Medications appropriate for rhythm and cond
ition * D - Differential Diagnosis: search for and treat reversible causes Epine
phrine 1 mg EV c / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5
min Maximum dose: 3 mg
2005 Guidelines for CPR - AHA