1. PUT IT ALL TOGETHER
ALS Subcommittee 2010

2. Collapsed patient
Without cardiac output
With cardiac output Shock-able rhythm
• Tachyarrhythmias • Ventricular fibrillation
• Bradyarrhythmias • Pulseless VT
Non shock-able rhythm
• Asystole
• Pulseless electrical
activity
ALS Subcommittee 2010

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

10. Bradyarrhythmias
• Symptomatic : medications ± pacing
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