3. VF / Pulseless VT
•Avoid Danger
•Check Responsiveness
•Shout: Activate emergency response system
Call for defibrillator and resus trolley
• A Airway: open the airway
• B Breathing: assess if no breathing or agonal breathing
• C Circulation: give chest compressions
• D Defibrillation: assess rhythm and shock VF/pulseless
VT (360J monophasic or 120-200J biphasic)
ALS Subcommittee 2010
4. VF / Pulseless VT …. cont
Resume attempts to defibrillate
1 x 360 J (or equivalent biphasic)
•Adrenaline 1 mg IV push, repeat every 3 to 5 minutes OR
Vasopressin 40 U IV, single dose, 1 time only
Chest
Resume attempts to defibrillate compression
1 x 360 J (or equivalent biphasic) continues
with
Consider antiarrhythmics:
minimal
•Amiodarone 300mg bolus OR
•Lignocaine 1mg/kg bolus interruptions
•Magnesium ( known hypomagnesemic state)
Resume attempts to defibrillate
ALS Subcommittee 2010
5. Asystole / PEA
•Avoid Danger
•Check Responsiveness
•Shout: Activate emergency response system
Call for defibrillator and resus trolley
• A Airway: open the airway
• B Breathing: assess if no breathing or agonal breathing
• C Circulation: give chest compressions
• D Defibrillation: non-shockable rhythm
ALS Subcommittee 2010
6. Asystole/ PEA ….cont
• Adrenaline 1 mg IV push
- repeat every 3 to 5 minutes
- vasopression 40U may replace 1 dose of
adrenaline
• CPR
• Drugs
• Determine causes of PEA or Asystole
- consider 6 Hs and 5 Ts
ALS Subcommittee 2010
7. Asystole/ PEA ….cont
• Consider quality of resuscitation?
• Atypical clinical features present?
• Consider ceasing resuscitation
• Search for DNR order
ALS Subcommittee 2010
8. Patient with pulse
• Reassurance
• Oxygen
• IV access
• Monitor
ALS Subcommittee 2010
9. Tachyarrhythmias
Stable Unstable
• Medications • Cardioversion
• ± maneuvers • Consider amiodarone
after 3x cardioversion
ALS Subcommittee 2010
11. Success Of CPR
• Team effort:
– good team members
– good team leader
– knowledge
11
ALS Subcommittee 2010
12. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
Dr Tan Cheng Cheng
Dr Luah Lean Wah
Dr Ismail Tan
Dr Wan Nasrudin
Dr Chong Yoon Sin
Dr Priya Gill
Dr Ridzuan bin Dato’ Mohd Isa
Dr Thohiroh Abdul Razak
Dr Adi Osman
ALS Subcommittee 2010