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 *
2010 Algorithm posters from the European Resuscitation Council
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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
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
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
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
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
blocker overdose)• Glycopyrrolate can be used instead of atropine
Seek expert helpArrange transvenous pacing
No
Yes No
Yes
observe
No
Yes
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
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
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
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