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Christopher Ryalino
American Heart Association
Guidelines for CPR 2015
• BLS
• ACLS
– Pulseless Arrest
– Bradycardia
– Tachycardia
• Post cardiac arrest care
Chains of Survival
2015 (New): Separate Chains of Survival (Figure 4) have
been recommended that identify the different pathways
of care for patients who experience cardiac arrest in the
hospital as distinct from out-of-hospital settings
“Chain of Survival”
in-hospital cardiac arrest (IHCA)
• Surveillance for cardiac arrest
• Activate code (multidisciplinary team)
• Initiate CPR by professional providers
• Early defibrillation
• Integrated post cardiac arrest care
“Chain of Survival”
out-of-hospital cardiac arrest (OHCA)
• Immediate recognition of cardiac arrest and
activation of the emergency response system
• Early CPR that emphasizes chest compressions
• Rapid defibrillation if indicated
• Effective advanced life support
• Integrated post cardiac arrest care
Adult Basic Life Support
(BLS)
Basic Life Support
CallPulse :breathing
for help and AED
Breathing 5-6 sec
and pulse
No pulse : CPR
The BLS Survey includes four steps:
The BLS survey is the starting point for all
ACLS management
• Check for a response
• Call for help and to bring an AED
• Check circulation
• Check rhythm
The Primary Assessment
The Primary Assessment uses the ABCDE model
• Airway – Use the least advanced airway possible to maintain
the airway and oxygenation
• Breathing – Monitor tube placement and oxygenation using
waveform capnography
• Circulation – Medications, CPR, fluids and defibrillation
• Differential Diagnosis –treat reversible causes
• Disability- neurological assessment “AVPU”(Alert, Voice,
Painful, Unresponsive)
• Exposure - looking for signs of trauma, bleeding,
burns, or medical alert bracelets
The Secondary Assessment
• The secondary assessment includes a search for
underlying causes for the emergency and if possible
a focused medical history “SAMPLE’
• (S)Signs and symptoms
• (A)Allergies
• (M)Medications
• (P)Past Illnesses
• (L)Last Oral Intake
• (E)Events Leading Up To Present Illness
Check pulse :carotid artery
Head tilt
Chin lift
Jaw thrust for C-spine injury
Breathing
BLS Dos and Don’ts of Adult High-Quality CPR
Allow full recoil after each compression Lean on the chest between compressions
AED ON
AED (Automated External Defibrillator)
AED (Automated External Defibrillator)
Advanced Cardiovascular
Life Support: ACLS
Advanced Cardiovascular Life
Support: ACLS
• Pulseless Arrest
• Bradycardia with Pulse
• Tachycardia with Pulse
Pulseless Arrest
shock
Hypovolemia Toxins
Hypoxia Tamponade
Tension PTX
Hydrogen ions (acidosis)
Hyper/hypokalemia Thrombosis (coronary)
Hypothermia Thrombosis (pulmonary)
Narrow irregular
120-200 j
(mono 200j)
Unstable
Tachycardia
Wide regular
100 j
Wide irregular
DF
Quantitative Waveform Capnography
• Confirmation and monitoring ETT placement
• Evaluating the effectiveness of chest compressions
ETCO2 value is at least 10-20 mmHg.
• Identification of ROSC
• Failure to achieve an ETCO2of greater than 10 mm Hg
by waveform capnography after 20 minutes of CPR
decide to end resuscitative efforts but should not be
used in isolation
Capnography Recommendation
CPR Quality
BT 32C-36C
at least 24 hr
High-Dose Epinephrine
NO PULSE
Supraventricular tachycardia
New and Updated Recommendations
CPR Guideline 2015
• Separate Chain of Survival