Advanced Life Support (ALS)

Last updated 20.09.12

 

Index

 

Definition

-  Management of the unconscious patient

 

Features

-   

 

Protocol

-  BLS

-  Assess rhythm

-  Shockable Rhythm: VF, Pulseless VT

-  Unwitnessed

-   1 DC shock biphasic 150-200J

-   Immediate CPR 2 min

-   Assess rhythm

-   Still shockable rhythm repeat as above

-   3rd shock proceeded by Adrenaline

-  1mg adults (1ml [all] of 1,1000 ampule)

-  10mcg/kg for children (use 1:10,000 ampule)

-   4th shock proceeded by Amiodarone

-  300 mg IV

-   5th, 7th.. shocks proceeded by Adrenaline

-  Witnessed

-   Precordial thump if defib not available

-   3 stacked DC shocks biphasic 150-200J

-   Abort if returns to sinus rhythm

-  Non Shockable Rhythm: PEA (Pulseless Electrical Activity), Asystole

-  Adrenaline IV

-   1mg adults (1ml [all] of 1,1000 ampule)

-   10mcg/kg for children (use 1:10,000 ampule)

-   Every 3 min

-  CPR 2 min

-  Children more common for non-shockable rhythms

-  When down time permits

-  IV access

-  Airway

-  Consider early esp if pregnant

-  O2

-  Correct Reversible Causes

-  4Hs

-   Hypoxaemia

-   Hypovolaemia

-   Hypo/hyperkalaemia

-   Hypo/hyperthermia

-  4Ts

-   Cardiac Tamponade

-   Tension pneumothorax

-   Thromboembolism (PE, AMI)

-   Toxins/Drugs/Poison

-  Consider Amiodarone, Atropine, Mg