Details dalam Algorithm (step by step)
1. Shockable rhythm HANYA VT & VF!!!!
- Check pulse, pulse not present. Immediate call for help
- Proceed with breathing (chest movement) 5 seconds. NO Chest movement, begin CPR
sampai bantuan tiba
Bantuan sampai, JANGAN stop chest compression (make sure bagi org lain yg buat CPR
sebab kita kena lekat AED pad pada pesakit. - - Semasa pasang pad tu, chest compression
tak boleh stop) + airway bag valve O2
Chest compression stop bila AED kata "stop CPR" and tengok monitor tu. Pastikan rhythm
VT/VF atau PEA/Asystole.
- Kalau monitor tunjuk VF/VT, kena shock pesakit secepat mungkin. (sementara AED tgh
recharge joules, teruskan chest compression sampailah button shock menyala baru stop
chest compression)
Sebelum release shock, jgn lupa " I CLEAR, U CLEAR, EVERYBODY CLEAR. Rhythm is
still VT/VF. SHOCK DELIVER IN 3 2 1 SHOCK). WAJIB sebut rhythm before SHOCK, klu
tak nanti dorang tukar rhythm last min. Mata kena tgok monitor masa shock tu.
- Dah bagi shock, terus continue CPR and PREPARE Ephinephrine (prepare sahaja tau, jgn
bagi lagi) + dapatkan IV line, ambil darah and send darah ke lab.
2. CPR Cycle 2
- Selesai CPR 2 min, ulang benda sama. Kalau shockable rhythm lagi, SHOCK lagi. TAPI
kali ni, bagi Ephinephrine yang kita dah prepare tadi.
- Lepas tu, PREPARE Amiodarone 300 mg (1st dose, prepare sahaja tau. Jangan bagi lagi).
- Andai kata, selesai CPR 2 min. Monitor tunjuk non-shockable rhythm PEA/Asystole. Just
continue dgn CPR and bagi Epinephrine. Tak perlu prepare Amiodarone.
- Cycle kedua dah perlu consider advance airway adjunct (bag valve tukar pada LMA).
3. CPR Cycle 3
- CPR 2 min, monitor rhythm.
Cycle ketiga, kalau rhythm still shockable, terus SHOCK lagi.
Settle shock, bagi Amiodarone 300 mg yg kita dh prepare tadi.
- Lepas tu, PREPARE second dose utk Amiodarone 150mg and Epinephrine 1mg. Prepare
je tau. Bagi pada next cycle.
Masa ni, bag valve mask dah tukar pada LMA.
-Sambung CPR kalau masih takde ROSC.
-Sementara nak habiskan CPR 2 min tu, dapatkan 5H 5T daripada family (nanti explain 5H
5T) and blood result/ABG (PH Level).
- Settle 2 min CPR, check rhythm. Shockable rhythm, SHOCK and proceed dgn second
dose Amiodarone 150 mg & Epinephrine 1 mg.
- Kalau Non shockable rhythm, continue CPR sahaja and bagi Epinephrine 1mg je.
Amiodarone tak payah.
4. Cek kalau pesakit dah ada ROSC
- Proceed dengan ROSC care sekiranya pesakit ada ROSC. Kalau takde ROSC, CPR lah
sampai betul2 dah tak larat (kena tahu syarat stop CPR apa).
- Treat reversible cause iaitu 5H 5T. Contoh 5H 5T. Masa pesakit dah ROSC, blood result
ABG yang kita ambik masa cycle pertama tu menunjukkan acidosis, so kena bagi sodium
bicarb, kalau alkalosis kena bagi potassium chloride.
5. ROSC (post cardiac arrest care)
- Airway. Proceed intubation. Maintain PETCO2 of 35-40 (ventilator). SPO2 up to 95% dan
ke atas.
- Maintain blood pressure. Avoid Hypotension. Infusion pump of Dopa/Noradrenaline & IV
NS maintai. BP Monitor
- Reflo
- Settlekan 5H 5T kalau masih ada
- TTM (Targetted Temperature Management) 32-36°C. Elak Hyperthermia. *****penting ni!!!!!
- ECG and cardiac monitoring
- Refer cardio and medical.
*** 5H 5T ***
[Link]
[Link]
[Link] ion (Acidosis)
[Link] & HypoK
[Link] (TTM)
[Link] (opiod/overdose)
[Link] (cardiac)
[Link] pneumothorax
[Link] (pulmonary embolism) paru-paru
[Link] (cardiac/MI) jantung
*** PH level ***
Acidosis ⬅️ 7.35-7.45 ➡️Alkalosis
(normal pH level 7.35-7.45)
- Acidosis bagi Sodium Bicarb
- Alkalosis bagi Pottasium Chloride
*kalau tak tau dos, jgn ckp. Sebut nama ubat je dah cukup.
*** Airway mx ***
M - mask
R - reposition
S - suctioning
O - open airway
L - LMA
*** Must know medication ***
- Adenosine untuk SVT - 1st dose 6mg (angkat tgn & rapid push), 2nd dose 12 mg.
- Amiodarone untuk after SHOCK VT/VF - 1st dose 300 mg, 2nd dose 150mg and so on.
- Atropine untuk bradycardia - 0.5 mg IV every 3 - 5 min. Max dose 3mg shj.
- Adrenaline / Epinephrine for cardiac resus - 1mg every 3 - 5 min. ( bukan every cycle of
CPR ye. Cukup 3-5 min selepas dos pertama, bagi second dose terus. Tak perlu tunggu
cycle CPR habis).
-Magnesium Sulphate untuk rhythm Torsades de pointes - 1to 2 gm IV bolus. ***** penting
ni!!!
Nota :
- Kalau pesakit stabil, treat dengan ubat dan oxygen dulu. - Kalau pesakit stabil tapi SVT,
kena start dengan Vagal maneuver atau neck massage, proceed dgn medication kalau vagal
maneuver tak berhasil.
- Pacing untuk pesakit yang tidak stable and Bradycardia shj.
- Cardioversion untuk pesakit yang tidak stable tetapi SVT shj.
- Shock untuk pt yang collapsed and shockable rhythm shj.
- Kena hafal ciri2 CPR yang efektif ( 5 benda tu)
- Jumlah compression dalam 1 cycle (100-120)
- Jumlah ventilation dalam 1 cycle (bag valve mask 6-10).
- Torsades de pointes ialah gabungan rhythm VT dan VF dalam satu ECG. Medication
Magnesium Sulphate.
- TTM 32-36°C.
- Pesakit ROSC tak semestinya sedar tau! Pulse present, breathing okay dah kira ROSC.
_________________________________________________
ACLS Cardiac Arrest VTach and VFib Algorithm
1. Perform the initial assessment
Perform high-quality CPR
Establish an airway and provide oxygen to keep oxygen saturation > 94%
Monitor the victim’s heart rhythm and blood pressure
2. If the patient is in VTach or VFib, this IS a shockable rhythm
3. Apply defibrillator pads (or paddles) and shock the patient with 120-200 Joules on a
biphasic defibrillator or 360 Joules using a monophasic.
4. Continue high-quality CPR for 2 minutes (while others are attempting to establish IV or IO
access).
5. After 2 minutes of CPR, check rhythm
6. If the monitor and assessment show asystole or PEA, move to Asystole/ PEA algorithm
7. Give epinephrine 1 mg every 3-5 minutes
8. Continue high-quality CPR for 2 minutes (while others are attempting to establish IV or IO
access).
9. After 2 minutes of CPR, check rhythm
10. If needed, administer shock
11. Amiodarone IV 300 mg (preferable to lidocaine); May repeat 150 mg OR may use
lidocaine 1-1.5 mg/kg
12. After 2 minutes of CPR, check rhythm
13. If needed, administer shock
14. If the patient attains Return of Spontaneous Circulation (ROSC), provide Post Cardiac
Arrest Care