AHA 2015 BLS Recommendations - Wizard Educationregistration.wizardeducation.com/pdfs/2020 ALSR Handouts.pdf · 2020. 11. 17. · AHA 2015 BLS Recommendations Attach and use AED as

Component Adults Children Infants

RecognitionNobreathingornonormalbreathing

(ieonlygasping)

Activation

CPRSequence

CompressionRate

Compressiondepth 2to2.4inches atleast1/3APdepthAbout2inches

atleast1/3APdepthAbout11/2inches

ChestWallRecoil

Compressionpauses

Airway

Compressiontoventilationratio(untiladvancedairwayplaced)

30to21or2rescuer

Ventilations:rescueruntrainedortrainedandnotproficient

Ventilations:BLSventilationsforpatientwithapulse(HCP)

1breathevery5to6seconds

Ventilationswithadvancedairway(HCP)

Defibrillation

1breathevery6seconds(10breaths/min)Asyncronouswithchestcompressions

About1secondperbreathVisiblechestrise

C-A-B

Headtiltchinlift(HCPsuspectedtrauma:jawthrust)

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AHA2015BLSRecommendations

AttachanduseAEDassoonasavailable.Minimizechestcompressionpausebeforeandaftereachshock.ResumeCPRbeginningwithcompressionaftereachshock

nobreathingoronlygasping

100to120perminute

AllowcompleterecoilbetweencompressionsMinimizepausesinchestcompressionsAttempttolimitpausesto<10sec

30to2singlerescuer15to22HCPrescuers

Unresponsive(forallages)

ActivateemergencyresponsesystemGetAED/Defibrillator

orsendsecondrescuer(ifavailable)

1breathevery3-5seconds

Compressionsonly

Medical Patient Assessment History Taking

S - Symptoms A - Allergies M - Medications P - Past Medical History L - Last Meal E - Events Prior R - Risk Factors

O - Onset P - Provocation Q - Quality R - Radiation S - Severity (1-10) T -Time

INCREASED ETCO2

DECREASED ETCO2

VentilationHypoventilation Bronchoconstriction Drug Overdose

Hyperventilation Dislodged ETT Tension Pneumo Equiment Failure

CirculationGood CPR ROSC é Cardiac Output

Low Cardiac Output Cardiac Arrest Pulmonary Edema Pulmonary Embolism

MetabolismFever/Hyperthermia Seizure Burns Muscle Use

DKA Sepsis Hypothermia

RHYTHM STABLE UNSTABLEBRADY ASYMPTOMATIC BRADY

Assess, observe, report ortransport PRN

SYMPTOMATIC BRADY-Atropine 0.5 mg IV every 3-5 minutes up to 3 mg.-Pace-Dopamine Drip 2-20 mcg/kg/min-Epi Drip 2-10 mcg/min

AFIBUNCONTROLLED

generally narrow and irregular

-Diltiazem . 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes may repeat in 0.35mg/kg in 15 min. Followed by infusion of 5-15 mg/hr-Verapamil2.5 - 5 mg slow IV push over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg/hr-Amiodarone 150mg/50cc D5w over ten minutes, may repeat q 10 minutes

Synchronized Cardioversion120-200 J

SVTSupraventricular

Regular narrow complex tachycardia

Vagal -Adenosine 6mg, 12 mg-Diltiazem 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes may repeat in 0.35mg/kg in 15 min. Followed by infusion of 5-15 mg/hr-Verapamil 2.5 - 5 mg slow IV push over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg

Synchronized Cardioversion50 - 100 J

MVTMonomorphic ventricular

tachycardia orRegular wide complex

tachycardia

Amio 150 mg over 10 minutesrepeat as needed/dripLidocaine 0.5 - 0.75 mg/kg, repeat q 5 minutes up to 3mg/kg and dripMay Consider Adenosine if regular

Synchronized Cardioversion100-200 J

Unresponsive Patient with LVAD

LVAD CODE PATIENT ASSESSMENT

LVAD RESTARTED?

ASSESS PATIENT Skin Color and Temperature

Doppler BP (MAP) Heart Rhythm

ASSESS PUMP

Listen for LVAD hum Look/Listen for Alarms on

Controller

Adequate Perfusion

with Pump Running

Pump

NOT Running

Assess and Treat Non-LVAD causes for Altered Mental

Status (Hs and Ts):

- Stroke (Hemorrhagic or Embolic)

- Arrhythmia - Hypoxia

- Hypoglycemia - Overdose

Pump Running

Questionable Perfusion

Yes

MAP > 50 PETCO2 > 20

ATTEMPT TO RESTART LVAD

- Connect Driveline - Connect Adequate Power

Intubated Patient)

Yes No

- Change Controller if instructed

Involve patient’s caregiver in

troubleshooting equipment

DO NOT PERFORM CPR

DO NOT PERFORM CPR

PERFORM CPR Notify VAD Team

No

Yes

ACTIVATE LVAD CODE CALL 757-388-2831

Ask Operator to Page LVAD Coordinator On-Call

for equipment issues MD on call for patient issues

Continue to follow ACLS Algorithms for Drug Recommendations

Encourage Patient’s Caregiver to come in the Ambulance to the Hospital

Ensure LVAD BACKUP equipment is ALWAYS available

*Patient may NOT have a palpable pulse or measurable BP.

*Pulse oximetry may NOT read appropriately.

*BP reading may have narrow pulse pressure values.

*MAP recommended range: 60‐90.

Revised - 7/10/2017 S:\hscgroups\CARDIAC TRANSPLANT\LVAD FILES\Guidelines and Protocols\VAD PROTOCOLS\Code

RSI ALGORITHMBenefits of obtaining airway control must be weighed

against the risk of complications caused by this procedure.

Assure adequate sedation during transportMorphine, 2-10 mg IV for pain managementValium, 5-10 IV as soon as ET placement confirmed

orVersed, 2-5 mg IV over 30 -60 Seconds, Q10 -15 mins PRNPlace NG Tube if time permitsreevaluate - Vital signs, Pulse Ox, Continuous ETCO2 Monitoring, EKG.

Auscultation, ETCO2 Detector (required), Pulse Ox, Observe chest rise and fall, re-visualize if needed

7.Post Intubation

6.Confirm Tube Placement.

If 1st attempt fails, ventilate with BVM/OPA, 100% O2 until next attemptIf 2nd attempt fails, ventilate with BVM/OPA, 100% O2 and reevaluateConsider use of Combitube to ensure adequate ventilation.Consider performing Cricothyrotomy if unable to adequately ventilate.

5.Intubate

Succinycholine clhoride (Anectine), 1.5 mg/kg IVMay repeat with 1.5 mg/kg PRN in 2 minutesFor continued paralysis - may repeat once

4.Paralyze

From sedative administration until ET Tube placement is confirmed.3.

Maintain Cricoid Pressure

Etomidate (Amidate), 0.3mg/kg IV over 30-60 secondsMay repeat with 0.3mg/kg in 2 minutes IF NEEDED2.

Sedate

4 to 5 minutes with 100% O2 or 4 vital capacity breaths with BVM if insufficient tidal volume1.

Preoxygenate prepare equipment

Kg Lbs mg ml mg ml30 66 9 4.5 45 2.335 77 11 5.3 53 2.640 88 12 6.0 60 3.045 99 14 6.8 68 3.450 110 15 7.5 75 3.855 121 17 8.3 83 4.160 132 18 9.0 90 4.565 143 20 9.8 98 4.970 154 21 10.5 105 5.375 165 23 11.3 113 5.680 176 24 12.0 120 6.085 187 26 12.8 128 6.490 198 27 13.5 135 6.895 209 29 14.3 143 7.1

100 220 30 15.0 150 7.5105 231 32 15.8 158 7.9110 242 33 16.5 165 8.3115 253 35 17.3 173 8.6120 264 36 18.0 180 9.0125 275 38 18.8 188 9.4130 286 39 19.5 195 9.8135 297 41 20.3 203 10.1140 308 42 21.0 210 10.5

Etomidate Succinylcholine

2mg/ml 20mg/ml0.3mg/Kg 1.5 mg/Kg

Wizard Education623-388-8900 / wizardeducation.com

Wizard Education623-388-8900 / wizardeducation.com

RSI ALGORITHMBenefits of obtaining airway control must be weighed

against the risk of complications caused by this procedure.

Assure adequate sedation during transportMorphine, 2-10 mg IV for pain managementValium, 5-10 IV as soon as ET placement confirmed

orVersed, 2-5 mg IV over 30 -60 Seconds, Q10 -15 mins PRNPlace NG Tube if time permitsreevaluate - Vital signs, Pulse Ox, Continuous ETCO2 Monitoring, EKG.

Auscultation, ETCO2 Detector (required), Pulse Ox, Observe chest rise and fall, re-visualize if needed

7.Post Intubation

6.Confirm Tube Placement.

If 1st attempt fails, ventilate with BVM/OPA, 100% O2 until next attemptIf 2nd attempt fails, ventilate with BVM/OPA, 100% O2 and reevaluateConsider use of Combitube to ensure adequate ventilation.Consider performing Cricothyrotomy if unable to adequately ventilate.

5.Intubate

Succinycholine clhoride (Anectine), 1.5 mg/kg IVMay repeat with 1.5 mg/kg PRN in 2 minutesFor continued paralysis - may repeat once

4.Paralyze

From sedative administration until ET Tube placement is confirmed.3.

Maintain Cricoid Pressure

Etomidate (Amidate), 0.3mg/kg IV over 30-60 secondsMay repeat with 0.3mg/kg in 2 minutes IF NEEDED2.

Sedate

4 to 5 minutes with 100% O2 or 4 vital capacity breaths with BVM if insufficient tidal volume1.

Preoxygenate prepare equipment

Kg Lbs mg ml mg ml30 66 9 4.5 45 2.335 77 11 5.3 53 2.640 88 12 6.0 60 3.045 99 14 6.8 68 3.450 110 15 7.5 75 3.855 121 17 8.3 83 4.160 132 18 9.0 90 4.565 143 20 9.8 98 4.970 154 21 10.5 105 5.375 165 23 11.3 113 5.680 176 24 12.0 120 6.085 187 26 12.8 128 6.490 198 27 13.5 135 6.895 209 29 14.3 143 7.1

100 220 30 15.0 150 7.5105 231 32 15.8 158 7.9110 242 33 16.5 165 8.3115 253 35 17.3 173 8.6120 264 36 18.0 180 9.0125 275 38 18.8 188 9.4130 286 39 19.5 195 9.8135 297 41 20.3 203 10.1140 308 42 21.0 210 10.5

Etomidate Succinylcholine

2mg/ml 20mg/ml0.3mg/Kg 1.5 mg/Kg

Wizard Education623-388-8900 / wizardeducation.com

Wizard Education623-388-8900 / wizardeducation.com

Document Glascow Coma Scoreprior to sedation.

Document Glascow Coma Scoreprior to sedation.

AEMS Red Book 2019

Page 37

Spinal Motion RestrictionBlunt Trauma Adult (≥ 15 y/o)

Last Revised November 14, 2018

Spinal Motion R

estriction Blunt Traum

a A

dult (≥ 15 y/o)

Patients without any of the above findings may be transported without the use of a cervical collar or any other means to restrict spinal motion.

Does the patient meet Adult Major Trauma Criteria with a BLUNT mechanism of injury (Trauma Triage)?

Spine injury should be suspected and the patient should be placed in a properly fitted cervical collar and spinal movement minimized.

If the patient does not meet Major Trauma Criteria for Blunt Mechanism, does the patient have any of the following:1. Altered mental status. For any reason including possible

intoxication from alcohol or drugs (GCS < 15)2. Age ≥ 653. Midline neck or back pain and/or tenderness4. Focal neurologic signs and/or symptoms (ie. Weakness,

tingling, or numbness)5. Anatomic deformity of the spine6. Painful distracting injury or circumstances (ie. Anything

producing an unreliable physical exam)7. High risk mechanism of injury associated with unstable

spinal injuries that include, but are not limited to:a. Axial load (ie. Diving injury, spearing tackle)b. High speed MVC or rolloverc. Pedestrian or bicyclist struck/collisiond. Falls > 8 feet/5 steps or patient’s height

• SMR may be achieved by use of a scoop stretcher, vacuum splint, ambulance stretcher, orlong spine board with patient safely secured.

• SMR when indicated should apply to the entire spine due to risk of noncontiguous injuries.This can be accomplished by use of a cervical collar and placing the patient on a longbackboard, scoop stretcher, vacuum splint, or ambulance stretcher.

• SMR cannot be properly performed with a patient in a sitting position.• If elevation of the head is required, the device used to stabilize the spine should be elevated

at the head while maintaining alignment of the neck and torso.• There is no role for SMR in penetrating trauma.

Yes No

Yes No

AEMS Red Book 2019

Page 38

Suspicion of a Traumatic Brain Injury (TBI) by mechanism, GCS, or Exam, then provide O2 15 L/min by NRB, establish IV access and monitor the patient’s O2, BP, and HR every 3-5 minutes.

EPIC TBI ManagementAdult (≥ 15 y/o)

CirculationSBP <90 or other signs of

shock

SBP <90 or other signs of shock

● 1000 bolus of NS/LR● Repeat 500 ml rapid

boluses until SBP >90● Continue careful

monitoring BP/HR● Pay attention for early

signs of shock:− Tachycardia− Dropping SBP

TBI M

anagement for A

gencies using EPIC

Adult (≥ 15 y/o)

Airway/BreathingO2 sat<90 &/or hypoventilation

(despite NRB)

DisabilityEvaluate Mental

Status/GCS

Evaluate Mental Status/GCS

Always evaluate for hypoglycemia.

● It can mimic or cause aTBI.

● Check blood glucose. If<70 mg/dl:− Dextrose per

Hypoglycemia off-lineIV/IO

− Repeat BG @ 10 min.Repeat previous dose X1 if still <70 mg/dl

Consider impendingherniation if:

● Dilated and unresponsivepupils

● GCS <9 or rapiddeterioration in GCS by>2 points

● Extensor posturing● Asymmetric pupils (one or

both non-reactive to light)● Re-evaluate every 3-5

minutes

If patient has signs ofimpending herniation.

● Elevate head of gurney30˚

DO NOT hyperventilate

O2 sat<90 &/or hypoventilation (despite NRB)

● BLS airway maneuvers● BVM 10/min● Careful monitoring of O2 sat

and airway● If O2 sat <90, despite BLS

consider ALS airway● Maintain ETCO2 between 35-

45 mmHg

If O2 sat <90, despite BLSconsider ALS airway

● Place advanced airway− Pre-oxygenate: BVM with 100% O2 @10 breaths/min− Check placement using ETCO2 detector and/or monitor

● Control ventilatory rate:▪ ETCO2 available: maintain ETCO2 between 35-45 mmHg▪ ETCO2 not available: utilize cadence device (rate 10bpm)

− Control ventilatory volume:▪ Ventilator available: utilize as soon as possible (Tidal volume= 7cc/kg)

▪ Ventilator not available: utilize pressure controlled bag● Monitor O2 sat and airway every 3-5 minutes

− If O2 sat <90, despite above interventions, consider:▪ Tension pneumothorax and needle thorocostomy

● Meds that can rapidly drop BP and rapidly reduce blood flowto brain: Morphine, Fentanyl, Midazolam (Versed), Diazepam(Valium), Lorazepam (Ativan). Use with caution and watch SBPcarefully. Don’t give if patient’s B/P is already low or falling.Start with VERY low doses (20-25% of usual dose).

Last Revised December 3, 2012