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AHA 2005

AHA 2005. ACLS Guidelines. Increased Emphasis On:. Effective CPR “Push hard and push fast” Chest compressions. Airway- New. 5 cycles of CPR/ 2 min prior to phoning 911 for infants/children No jaw thrust (lay people)

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AHA 2005

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  1. AHA 2005 ACLS Guidelines

  2. Increased Emphasis On: • Effective CPR • “Push hard and push fast” • Chest compressions

  3. Airway- New • 5 cycles of CPR/ 2 min prior to phoning 911 for infants/children • No jaw thrust (lay people) • Health care providers may use head-chin tilt in injured patients if jaw thrust fails

  4. Airway- Old • 1 min of CPR prior to phoning 911 for infants/children • Jaw thrust only for injured patients (both health care providers and lay people)

  5. Breathing • ALL rescue breaths over 1 s, with adequate volume to produce visible chest rise • Lay people: check for normal breathing in adults • Normal (not deep) breath prior to AR • Continuous cycles when intubated only • 8-10 resps per min when intubated (q 6-8 s) • No rescue breathing without compressions for lay people

  6. Breathing- Old • Rescue breaths over 1-2 s • Varying tidal volumes suggested • 10-12 resps/min once intubated

  7. Circulation- New • Single compression to ventilation ratio for ALL single rescuers for ALL victims (excluding newborns) • 30:2 (100/min) • 5 cycles (2 min) CPR in between rhythm checks • Health care providers (2 rescuer): • Adults 30:2 • Infants/children 15:2

  8. Circulation- New • Limit interruptions in compressions • Rescuers may use one or two hands for child CPR • Unwitnessed arrests: may consider 5 cycles of CPR prior to defibrillation (or response time > 4 min)

  9. Circulation- Old • Minimizations in interruptions not emphasized • Adult: 15:2 • Infant and child: 5:1 • Rhythm and pulse checks after defibrillation

  10. Defibrillation- New • Single shocks followed by immediate CPR for VF/ pulseless VT • 360 J for monophasic defibrillators • Biphasic defibrillators: device dependent (120-200 J) • No rhythm/pulse check prior to initial 5 cycles, then pulse check only if organized rhythm present • Rhythm checks every 5 cycles (2 min)

  11. Defibrillation- Old • 3 stacked shocks for initial defibrillation • 200 J, 300 J, 360 J • Single shock for subsequent defibrillations • 360 J

  12. Adjuncts • AED’s • Use of AED’s in children 1-8 years old (use pediatric system if available) • New AED’s will prompt rescuers for reassessment • Single shocks without rhythm check following • Use as soon as available except out of-hospital HC provider with child (not sudden arrest) or adult (unwitnessed arrest) • 5 cycles CPR prior

  13. Adjuncts • Airway: • LMA/Combitubes • Pacing: • No longer used in asystolic arrest

  14. Algorithms • Polymorphic VT • Unsynchronized (defibrillation) shocks • Bradycardia • Atropine dose 0.5 mg • Arrest • Drugs timed to be delivered with CPR ASAP after rhythm check • VF/ pulseless VT • Antiarrhythmics: Amiodarone preferred, then lidocaine

  15. Algorithms • Tachycardia • Simplified to one algorithm • Wide vs narrow complex; irreg vs reg • Simplified suggested drugs

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