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The Cardiothoracic Advanced Life Support Course : Delivering Significant Improvements In Emergency Cardiothoracic Care J. Dunning, T. Strang, S Ariffin, J Jerstice, D Danitsch, and A. Levine James Cook University Hospital, Middlesbrough, UK Wythenshawe Hospital, Manchester, UK
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Delivering Significant Improvements In Emergency Cardiothoracic Care
J. Dunning, T. Strang, S Ariffin, J Jerstice,
D Danitsch, and A. Levine
James Cook University Hospital, Middlesbrough, UK
Wythenshawe Hospital, Manchester, UK
University Hospital of North Staffordshire, Stoke-on-Trent,UK
Mackay JH, Powell SJ, Osgathorp J, Rozario CJ. EJCTS 2002
1 loop of unresponsive VF/VT or 2 loops of non VF/VT.
Pottle A, Bullock I, Thomas J, Scott L Resuscitation 2002
Commence Basic Life Support CPR 30:2
If ventilated turn FiO2 to
100%. If necessary hand ventilate at 100% O2
+/- Check Pulse
Correct reversible causes
If not already:
Check electrodes, paddle
position and contact
Attempt/verify: airway & 02 intravenous access
Give epinephrine every 3 min
amiodarone, atropine/ pacing ,
If Pacing wires in situ set to DDD at 90bpm, 10V.
Give 3mg atropine
Re-open chest if
Non VF/VT rhythm
established (see protocol)
Re-open chest if 3 shocks fail. (see protocol)
Potential reversible causes:
CPR 3 mins
1 min if immediately after defibrillation
CPR x 1 min
CALS Cardiac Arrest Protocol
check air entry bilaterally. Bag-valve.
if fail, prepare internal paddles.
Non VF/VT or failure to gain output with 3 shocks
3 causes of Hypotension
EXAMPLES : Treating Atrial fibrillation with a BP of 60/40 with amiodarone,
electing to wait for FFP and platelets in a patient bleeding 600mls in half an hour with no coagulopathy,
Giving colloid to a patient with left ventricular failure and a CVP of 25, Giving digoxin to treat a ventricular tachycardia (190bpm with a BP of 70/40).
POST TEST re-opening a patient that was tamponading without requesting an echo to confirm the diagnosis,
Starting adrenaline on a hypotensive patient who had a low blood pressure due to an SVT.
Mean : 9