Flujogramas Europa 2010 Poster RCP

european
resuscitation
council
18 de 0ctubre de 2010 www.elsuapdetodos.com
Basic Life Support &

Automated External Defibrillation
Check response
Shake gently
Ask loudly: Are you all right?
If not responsive
to
do
s.c
om
Open airway & check for breathing
If not breathing normally

or not breathing
If breathing normally
Call 112, find & bring an AED
de
Start CPR immediately
ap
Place your hands in the centre of the chest

Deliver 30 chest compressions:
Call 112
Continue to assess that breathing
remains normal
ww
w.
el
su
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
*
Turn into recovery position
CPR 30:2
Switch on the AED & attach pads

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: dont interrupt CPR
Stand clear & deliver shock

Nobody should touch the victim
- during analysis
- during shock delivery
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*.
www.erc.edu | info@erc.edu
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
european
resuscitation
council
In-hospital Resuscitation
Collapsed/sick patient
to
do
s.c
om
Shout for HELP

& assess patient
If signs of life
de
If NO signs of life
su
ap
Call resuscitation team
el
CPR 30:2
Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access
ww
w.
with oxygen and airway adjuncts

If appropriate
Apply pads/monitor
Attempt defibrillation
if appropriate
Handover to
resuscitation team
Advanced Life Support

when resuscitation team arrives
Product reference: Poster_10_IHBLS_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
council
In-hospital Resuscitation
os
.co
Collapsed/sick patient
ap
d
et
od
Shout for HELP & assess patient

Signs of life?
Yes
ww
w.
el
su
No
Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access
CPR 30:2
with oxygen and airway adjuncts
Apply pads/monitor
Attempt defibrillation if appropriate

when resuscitation team arrives

If appropriate
Handover to resuscitation team
www.erc.edu | info@erc.edu | 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
european
resuscitation
council

Universal Algorithm
Unresponsive?
Not breathing or only occasional gasps
Call
Resuscitation Team
to
do
s.c
om
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions
de
Assess
rhythm
Non-shockable
(PEA/Asystole)
ww
w.
1 Shock
el
su
ap
Shockable
(VF/Pulseless VT)
Immediately resume:
CPR for 2 min
Return of
spontaneous
circulation
Immediate post cardiac

arrest treatment
Use ABCDE approach
Controlled oxygenation and
ventilation
12-lead ECG
Treat precipitating cause
Temperature control /
therapeutic hypothermia
Immediately resume:
CPR for 2 min
During CPR
Reversible causes
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
Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Thrombosis
Tamponade - cardiac
Toxins
Tension pneumothorax
Product reference: Poster_10_ALS_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
council

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)
Assess for evidence of adverse signs:

1 Shock
2 Syncope
3 Myocardial ischaemia
4 Heart failure
No
to
do
s.c
om
Yes
de
Atropine
500 mcg IV
Satisfactory
Response?
ap
Yes
Yes
ww
w.
el
su
No
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*
Risk of asystole?
Recent asystole
Mbitz II AV block
Complete heart block with broad QRS
Ventricular pause > 3s
No
OR
Transcutaneous pacing
Seek expert help

Arrange transvenous pacing
Observe
* Alternatives include:
Aminophylline
Dopamine
Glucagon (if beta-blocker or calcium channel
blocker overdose)
Glycopyrrolate can be used instead of atropine
Product reference: Poster_10_ALS-BRAD_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
council
.co
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)
Tachycardia Algorithm
Unstable
Is QRS narrow (< 0.12 sec)?
Stable
Amiodarone 300 mg IV over

10-20 min and repeat shock;
followed by:
Amiodarone 900 mg over 24 h
et
od
Up to 3 attempts
os
Synchronised DC Shock*
Assess for evidence of adverse signs

1. Shock
2. Syncope
3. Myocardial ischaemia
4. Heart failure
ww
w.
Seek expert help
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)
*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia
Narrow
Regular
su
Irregular
el
Broad QRS
Is QRS regular?
ap
d
Broad
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
Narrow QRS
Is 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?
Irregular
Irregular Narrow Complex

Tachycardia
Probable atrial fibrillation
Control rate with:
-Blocker or diltiazem
Consider digoxin or amiodarone
if evidence of heart failure
Anticoagulate if duration > 48h
No
Seek expert help
Yes
Probable re-entry PSVT:

Record 12-lead ECG in sinus rhythm
If recurs, give adenosine again &
consider choice of anti-arrhythmic
prophylaxis
Possible atrial flutter

Control rate (e.g. -Blocker)
www.erc.edu | info@erc.edu | 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
european
resuscitation
council
Paediatric Basic Life support

Health professionals with a duty to respond
UNRESPONSIVE?
to
do
s.c
om
Shout for help
de
Open airway
su
ap
NOT BREATHING NORMALLY?
ww
w.
el
5 rescue breaths
NO SIGNS OF LIFE?
15 chest compressions
2 rescue breaths
15 compressions
After 1 minute of CPR call national emergency number (or 112)
or cardiac arrest team
Product reference: Poster_10_PaedBLS_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
council
Paediatric Life Support

Unresponsive?
Not breathing or only occasional gasps
CPR (5 initial breaths then 15:2)

Attach defibrillator/monitor
Call Resuscitation
Team
to
do
s.c
om
(1 min CPR first, if alone)
Assess
rhythm
Non-shockable
(PEA/Asystole)
ww
w.
1 Shock 4 J/Kg
el
su
ap
de
Shockable
(VF/Pulseless VT)
Immediately resume:
CPR for 2 min
Return of
spontaneous
circulation
Immediate post cardiac

arrest treatment
Use ABCDE approach
Controlled oxygenation and
ventilation
Investigations
Treat precipitating cause
Temperature control
Therapeutic hypothermia?
Immediately resume:
CPR for 2 min
During CPR
Reversible causes
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
Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Tension pneumothorax
Toxins
Tamponade - cardiac
Thromboembolism
Product reference: Poster_10_PALS_01_01_ENG Copyright European Resuscitation Council
european
resuscitation
council
Dry the baby
Birth
Assess (tone),
breathing and heart rate
30 sec
to
do
s.c
om
Remove any wet towels and cover

Start the clock or note the time
If gasping or not breathing

Open the airway
Give 5 inflation breaths
Consider SpO2 monitoring
60 sec
ap
de
Re-assess
If no increase in heart rate
Look for chest movement
If chest not moving
el
su
Recheck head position

Consider two-person airway control
or other airway manoeuvres
Repeat inflation breaths
ww
w.
At all stages ask: Do you need HELP?
Newborn Life Support
Consider SpO2 monitoring

Look for a response
Acceptable
pre-ductal SpO2
2 min: 60%
3 min: 70%
4 min: 80%
5 min: 85%
10 min: 90%
If no increase in heart rate

Look for chest movement
When the chest is moving
If the heart rate is not detectable or slow (< 60)

Start chest compressions
3 compressions to each breath
Reassess heart rate

every 30 seconds
If the heart rate is not detectable or slow (< 60)
Consider venous access and drugs
Product reference: Poster_10_NLS_01_01_ENG Copyright European Resuscitation Council

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european

18 de 0ctubre de 2010 www.elsuapdetodos.com

Basic Life Support &

Open airway & check for breathing

If not breathing normally

Call 112, find & bring an AED

Start CPR immediately

Place your hands in the centre of the chest

Press firmly at least 5 cm deep

Switch on the AED & attach pads

Stand clear & deliver shock

18 de 0ctubre de 2010 www.elsuapdetodos.com

Shout for HELP

Call resuscitation team

with oxygen and airway adjuncts

Call resuscitation team

Advanced Life Support

18 de 0ctubre de 2010 www.elsuapdetodos.com

Shout for HELP & assess patient

Call resuscitation team

with oxygen and airway adjuncts

Advanced Life Support

Call resuscitation team

Handover to resuscitation team

18 de 0ctubre de 2010 www.elsuapdetodos.com

Advanced Life Support

Immediate post cardiac

Ensure high-quality CPR: rate, depth, recoil

18 de 0ctubre de 2010 www.elsuapdetodos.com

Advanced Life Support

Assess for evidence of adverse signs:

Seek expert help

18 de 0ctubre de 2010 www.elsuapdetodos.com

Advanced Life Support

Assess using the ABCDE approach

Is QRS narrow (< 0.12 sec)?

Amiodarone 300 mg IV over

Assess for evidence of adverse signs

Seek expert help

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

Use vagal manoeuvres

Normal sinus rhythm restored?

Irregular Narrow Complex

Seek expert help

Probable re-entry PSVT:

Possible atrial flutter

18 de 0ctubre de 2010 www.elsuapdetodos.com

Paediatric Basic Life support

Shout for help

NOT BREATHING NORMALLY?

18 de 0ctubre de 2010 www.elsuapdetodos.com

Paediatric Life Support

CPR (5 initial breaths then 15:2)

(1 min CPR first, if alone)

Immediate post cardiac

Ensure high-quality CPR: rate, depth, recoil

18 de 0ctubre de 2010 www.elsuapdetodos.com

Dry the baby

Remove any wet towels and cover

If gasping or not breathing

If chest not moving

Recheck head position

At all stages ask: Do you need HELP?

Newborn Life Support