9
EUROPEAN RESUSCITATION COUNCIL www.erc.edu | [email protected] Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium Product reference: Poster_10_BLSAED_01_01_ENG Copyright European Resuscitation Council Place your hands in the centre of the chest Deliver 30 chest compressions: Press firmly at least 5 cm deep at a rate of at least 100/min Seal your lips around the mouth Blow steadily until the chest rises Give next breath when the chest falls Continue CPR CPR 30:2 Call 112, find & bring an AED If the victim starts to wake up: to move, to open eyes and to breathe normally, stop CPR. If still unconscious, turn him into the recovery position*. Check response If not responsive Basic Life Support & Automated External Defibrillation Start CPR immediately Switch on the AED & attach pads Stand clear & deliver shock Shake gently Ask loudly: “Are you all right?” Open airway & check for breathing If not breathing normally or not breathing If breathing normally Follow the voice prompts immediately Attach one pad below the left armpit Attach the other pad below the right collar bone, next to the breastbone If more than one rescuer: don’t interrupt CPR Nobody should touch the victim - during analysis - during shock delivery Turn into recovery position Call 112 Continue to assess that breathing remains normal *

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Page 1: All posters gl2010_english

european resuscitation council

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_BLSAED_01_01_ENG Copyright European Resuscitation Council

Place your hands in the centre of the chestDeliver 30 chest compressions:

• Press firmly at least 5 cm deep at a rate of at least 100/min• Seal your lips around the mouth• Blow steadily until the chest rises• Give next breath when the chest falls• Continue CPR

CPR 30:2

Call 112, find & bring an AED

If the victim starts to wake up: to move, to open eyes and to breathe normally, stop CPR.If still unconscious, turn him into the recovery position*.

Check response

If not responsive

Basic life support &automated external Defibrillation

Start CPR immediately

Switch on the AED & attach pads

Stand clear & deliver shock

Shake gentlyAsk loudly: “Are you all right?”

Open airway & check for breathing

If not breathing normally or not breathing If breathing normally

Follow the voice prompts immediatelyAttach one pad below the left armpitAttach the other pad below the right collar bone, next to the breastboneIf more than one rescuer: don’t interrupt CPR

Nobody should touch the victim- during analysis- during shock delivery

turn into recovery position

• Call 112• Continue to assess that breathing remains normal

*

Page 2: All posters gl2010_english

Assess ABCDERecognise & treat

Oxygen, monitoring, iv access

Call resuscitation teamIf appropriate

Handover to resuscitation team

european resuscitation council

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_IHBLS_01_01_ENG Copyright European Resuscitation Council

Call resuscitation team

CPR 30:2

with oxygen and airway adjuncts

Apply pads/monitor

Attempt defibrillation if appropriate

Shout for HELP & assess patient

advanced life supportwhen resuscitation team arrives

Collapsed/sick patient

in-hospital resuscitation

If NO signs of life If signs of life

Page 3: All posters gl2010_english

In-hospital Resuscitation

Collapsed/sick patient

Shout for HELP & assess patient

Assess ABCDERecognise & treat

Oxygen, monitoring, iv access

Call resuscitation teamIf appropriate

Handover to resuscitation team

Call resuscitation team

CPR 30:2 with oxygen and airway adjuncts

Apply pads/monitorAttempt defibrillation if appropriate

Advanced Life Support when resuscitation team arrives

No YesSigns of life?

euRopean ResuscItatIon councIl

www.erc.edu | [email protected] | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_IHBLS-A_01_01_ENG Copyright European Resuscitation Council

Page 4: All posters gl2010_english

european resuscitation council

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_ALS_01_01_ENG Copyright European Resuscitation Council

advanced life supportUniversal Algorithm

Unresponsive?Not breathing or only occasional gasps

CallResuscitation Team

CPR 30:2Attach defibrillator/monitor

Minimise interruptions

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

1 Shock

Immediately resume:CPR for 2 min

Minimise interruptions

Immediately resume:CPR for 2 min

Minimise interruptions

Return ofspontaneous

circulation

Assessrhythm

DuriNg CPr• Ensure high-quality CPR: rate, depth, recoil• Plan actions before interrupting CPR• Give oxygen• Consider advanced airway and capnography• Continuous chest compressions when advanced airway in place• Vascular access (intravenous, intraosseous)• Give adrenaline every 3-5 min• Correct reversible causes

rEVErSiblE CAuSES• Hypoxia• Hypovolaemia• Hypo-/hyperkalaemia/metabolic• Hypothermia

• Thrombosis• Tamponade - cardiac• Toxins• Tension pneumothorax

immEDiATE PoST CArDiAC ArrEST TrEATmENT• Use ABCDE approach• Controlled oxygenation and

ventilation• 12-lead ECG• Treat precipitating cause• Temperature control /

therapeutic hypothermia

Page 5: All posters gl2010_english

european resuscitation council

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_ALS-BRAD_01_01_ENG Copyright European Resuscitation Council

advanced life support Bradycardia Algorithm

• 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)

risk of asystole?• Recent asystole• Möbitz II AV block• Complete heart block with broad QRS• Ventricular pause > 3s

Atropine500 mcg IV

SatisfactoryResponse?

Assess for evidence of adverse signs:1 Shock2 Syncope3 Myocardial ischaemia4 Heart failure

interim measures:• Atropine 500 mcg IV repeat to maximum of 3 mg• Isoprenaline 5 mcg min-1

• Adrenaline 2-10 mcg min-1

• Alternative drugs*

or• Transcutaneous pacing

* Alternatives include:• Aminophylline• Dopamine• Glucagon (if beta-blocker or calcium channel

blocker overdose)• Glycopyrrolate can be used instead of atropine

Seek expert helpArrange transvenous pacing

No

Yes No

Yes

observe

No

Yes

Page 6: All posters gl2010_english

www.erc.edu | [email protected] | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_ALS-TACH_01_01_ENG Copyright European Resuscitation Council

• 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)

Narrow QRSIs rhythm regular?

• Use vagal manoeuvres• Adenosine 6 mg rapid IV bolus;

if unsuccessful give 12 mg; if unsuccessful give further 12 mg.

• Monitor ECG continuously

Normal sinus rhythm restored?

Possible atrial flutter• Control rate (e.g. ß-Blocker)

Probable re-entry PSVT:• Record 12-lead ECG in sinus rhythm• If recurs, give adenosine again &

consider choice of anti-arrhythmic prophylaxis

Irregular Narrow Complex TachycardiaProbable atrial fibrillationControl rate with:• ß-Blocker or diltiazem• Consider digoxin or amiodarone

if evidence of heart failureAnticoagulate if duration > 48h

Assess for evidence of adverse signs 1. Shock 2. Syncope 3. Myocardial ischaemia 4. Heart failure

Synchronised DC Shock*Up to 3 attempts

• Amiodarone 300 mg IV over 10-20 min and repeat shock; followed by:

• Amiodarone 900 mg over 24 h

Broad QRSIs QRS regular?

Possibilities include:• AF with bundle branch block

treat as for narrow complex• Pre-excited AF

consider amiodarone• Polymorphic VT

(e.g. torsades de pointes - give magnesium 2 g over 10 min)

If Ventricular Tachycardia (or uncertain rhythm):• Amiodarone 300 mg IV over

20-60 min; then 900 mg over 24 h

If previously confirmed SVT with bundle branch block:• Give adenosine as for regular

narrow complex tachycardia

*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia

Seek expert help

Yes

No

Unstable

IrregularRegular

NarrowBroad

Stable

RegularIrregular

Is QRS narrow (< 0.12 sec)?

Seek expert help

Advanced Life SupportTachycardia Algorithm

euRoPeAN ReSuSCITATIoN CouNCIL

Page 7: All posters gl2010_english

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_PaedBLS_01_01_ENG Copyright European Resuscitation Council

Paediatric Basic Life supportHealth professionals with a duty to respond

euroPean resuscitation counciL

Shout for help

Open airway

NOT BREATHING NORMALLY?

5 rescue breaths

2 rescue breaths15 compressions

NO SIGNS OF LIFE?

15 chest compressions

UNRESPONSIVE?

After 1 minute of CPR call national emergency number (or 112) or cardiac arrest team

Page 8: All posters gl2010_english

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_PALS_01_01_ENG Copyright European Resuscitation Council

Paediatric Life SupportAdvanced Life Support

Unresponsive?Not breathing or only occasional gasps

Call Resuscitation Team

(1 min CPR first, if alone)

CPR (5 initial breaths then 15:2)Attach defibrillator/monitor

Minimise interruptions

Shockable(VF/Pulseless VT)

Non-shockable(PEA/Asystole)

1 Shock 4 J/Kg

Immediately resume:CPR for 2 min

Minimise interruptions

Immediately resume:CPR for 2 min

Minimise interruptions

Return ofspontaneous

circulation

Assessrhythm

DuriNg CPr• Ensure high-quality CPR: rate, depth, recoil• Plan actions before interrupting CPR• Give oxygen• Vascular access (intravenous, intraosseous)• Give adrenaline every 3-5 min• Consider advanced airway and capnography• Continuous chest compressions when advanced airway in place• Correct reversible causes

rEVErSiblE CAuSES• Hypoxia• Hypovolaemia• Hypo-/hyperkalaemia/metabolic• Hypothermia

• Tension pneumothorax• Toxins• Tamponade - cardiac• Thromboembolism

immEDiATE PoST CArDiAC ArrEST TrEATmENT• Use ABCDE approach• Controlled oxygenation and

ventilation• Investigations• Treat precipitating cause• Temperature control• Therapeutic hypothermia?

euroPean reSuScitation counciL

Page 9: All posters gl2010_english

www.erc.edu | [email protected]

Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, BelgiumProduct reference: Poster_10_NLS_01_01_ENG Copyright European Resuscitation Council

Newborn Life Support

europeaN reSuScitatioN couNciL

Dry the babyRemove any wet towels and cover

Start the clock or note the time

If gasping or not breathingOpen the airway

Give 5 inflation breathsConsider SpO2 monitoring

if chest not movingRecheck head position

Consider two-person airway controlor other airway manoeuvres

Repeat inflation breathsConsider SpO2 monitoring

Look for a response

Reassess heart rate every 30 seconds

If the heart rate is not detectable or slow (< 60)Consider venous access and drugs

If no increase in heart rateLook for chest movement

When the chest is movingIf the heart rate is not detectable or slow (< 60)

Start chest compressions3 compressions to each breath

At A

LL S

tAG

ES A

Sk: D

O y

Ou

NEE

D H

ELP?

Assess (tone), breathing and heart rate

Acceptable pre-ductal SpO2

2 min: 60%

3 min: 70%

4 min: 80%

5 min: 85%

10 min: 90%

30 sec

60 sec

Birth

Re-assessIf no increase in heart rateLook for chest movement