ERC. Summary of the main changes in the Resuscitation Guidelines (eng.)

24 Pages·1.077 MB·English

euRopean
ReSuScitation
council
Summary
of the main
changes in the
Resuscitation
Guidelines
eRc GuidelineS 2010
2
E u r o p e a n
R e s u s c i t a t i o n
C o u n c i l
To preser ve human life by mak ing
high quality resuscitation available to all
The Network of National Resuscitation Councils
Published by:
european Resuscitation council Secretariat vzw,
Drie Eikenstraat 661 - BE 2650 Edegem - Belgium
Website: www.erc.edu
Email: [email protected]
Tel: [phone]
© European Resuscitation Council 2010.
All rights reserved. We encourage you to send this document to
other persons as a whole in order to disseminate the ERC Guidelines.
No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise for commercial
purposes, without the prior written permission of the ERC.
Version1.2
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publisher for any injury and/or damage to persons or property as
a matter of products liability, negligence or otherwise, or from any
use or operation of any methods, products, instructions or ideas
contained in the material herein.
3
Summary of main changes since 2005 Guidelines
Basic life support
improve the quality of CPR perform-
ance and provide feedback to pro-
Changes in basic life support (BLS) since
fessional rescuers during debriefing
the 2005 guidelines include:
sessions.
♦♦Dispatchers should be trained to
interrogate callers with strict protocols electrical therapies:
to elicit information. This information automated external defi-
should focus on the recognition of brillators, defibrillation,
unresponsiveness and the quality of cardioversion and pacing
breathing. In combination with unre-
sponsiveness, absence of breathing or
The most important changes in the 2010
any abnormality of breathing should
ERC Guidelines for electrical therapies
start a dispatch protocol for suspect- include:
ed cardiac arrest. The importance of
gasping as sign of cardiac arrest is
emphasised. ♦♦The importance of early, uninter-
rupted chest compressions is empha-
sised throughout these guidelines.
♦♦All rescuers, trained or not, should
provide chest compressions to victims
of cardiac arrest. A strong empha- ♦♦Much greater emphasis on mini-
sis on delivering high quality chest mising the duration of the pre-shock
compressions remains essential. The and post-shock pauses; the continua-
aim should be to push to a depth of tion of compressions during charging
at least 5 cm at a rate of at least 100 of the defibrillator is recommended.
compressions min-1, to allow full chest
recoil, and to minimise interruptions
in chest compressions. Trained rescu- ♦♦Immediate resumption of chest
ers should also provide ventilations compressions following defibrillation
with a compression–ventilation (CV) is also emphasised; in combination
ratio of 30:2. Telephone-guided chest with continuation of compressions
compression-only CPR is encouraged during defibrillator charging, the
for untrained rescuers. delivery of defibrillation should be
achievable with an interruption in
chest compressions of no more than 5
♦♦The use of prompt/feedback devic- seconds.
es during CPR will enable immediate
feedback to rescuers and is encour-
aged. The data stored in rescue equip- ♦♦Safety of the rescuer remains par-
ment can be used to monitor and amount, but there is recognition in
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Adult Basic Life Support
UNRESPONSIVE?
Shout for help
Open airway
NOT BREATHING NORMALLY?
Call 112*
30 chest compressions
2 rescue breaths
30 compressions
*or national emergency number
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Adult Basic Life Support Automated External Defibrillation
Unresponsive?
Call for help
Open airway
Not breathing normally
Send or go for AED
Call 112*
* or national emergency number
CPR 30:2
Until AED is attached
AED
assesses
rhythm
Shock No shock
advised advised
1 Shock
Immediately resume: Immediately resume:
CPR 30:2 CPR 30:2
for 2 min for 2 min
Continue until the victim starts
to wake up: to move, opens
eyes and to breathe normally
*or national emergency number
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A
w ttem w
hen resuscitation team arrivesAdvanced Life Support pt defibrillation if appropriaApply pads/monitor ith oxygen and airway adjunctsCPR 30:2 Call resuscitation team No
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dover to resuscitation team If appropriateCall resuscitation team ygen, monitoring, iv accessRecognise & treatAssess ABCDE Yes
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adult advanced life
these guidelines that the risk of harm
support
to a rescuer from a defibrillator is very
small, particularly if the rescuer is
The most important changes in the 2010
wearing gloves. The focus is now on a
ERC Advanced Life Support (ALS) Guide-
rapid safety check to minimise the pre-
lines include:
shock pause.
♦♦Increased emphasis on the
♦♦When treating out-of-hospital car- importance of minimally interrupt-
diac arrest, emergency medical serv- ed high-quality chest compressions
ices (EMS) personnel should provide throughout any ALS intervention:
good-quality CPR while a defibrillator chest compressions are paused briefly
is retrieved, applied and charged, but only to enable specific interventions.
routine delivery of a pre-specified peri-
od of CPR (e.g., two or three minutes)
before rhythm analysis and a shock is ♦♦Increased emphasis on the use of
delivered is no longer recommended. ‘track and trigger systems’ to detect
For some EMS that have already fully the deteriorating patient and enable
implemented a pre-specified period of treatment to prevent in-hospital car-
chest compressions before defibrilla- diac arrest.
tion, given the lack of convincing data
either supporting or refuting this strat-
egy, it is reasonable for them to con- ♦♦Increased awareness of the warn-
tinue this practice. ing signs associated with the poten-
tial risk of sudden cardiac death out of
hospital.
♦♦The use of up to three-stacked
shocks may be considered if VF/VT
occurs during cardiac catheterisation ♦♦Removal of the recommendation
or in the early post-operative period for a pre-specified period of cardiop-
following cardiac surgery. This three- ulmonary resuscitation (CPR) before
shock strategy may also be considered out-of-hospital defibrillation following
for an initial, witnessed VF/VT cardiac cardiac arrest unwitnessed by the EMS.
arrest when the patient is already con-
nected to a manual defibrillator.
♦♦Continuation of chest compres-
sions while a defibrillator is charged -
♦♦Further development of AED pro- this will minimise the pre-shock pause.
grammes is encouraged – there is a
need for further deployment of AEDs
in both public and residential areas. ♦♦The role of the precordial thump is
de-emphasised.
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Advanced Life Support
Unresponsive?
Not breathing or only occasional
gasps
Call
Resuscitation Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions
Assess
rhythm
Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)
Return of
1 Shock spontaneous
circulation
Immediately resume: Immediate post cardiac Immediately resume:
CPR for 2 min arrest treatment CPR for 2 min
• Use ABCDE approach
Minimise interruptions Minimise interruptions
• Controlled oxygenation and
ventilation
• 12-lead ECG
• Treat precipitating cause
•Temperature control / therapeu-
tic hypothermia
During CPR Reversible causes
• Ensure high-quality CPR: rate, depth, recoil • Hypoxia
• Plan actions before interrupting CPR • Hypovolaemia
• Give oxygen • Hypo-/hyperkalaemia/metabolic
• Consider advanced airway and capnography • Hypothermia
• Continuous chest compressions when advanced airway in place
• Thrombosis
• Vascular access (intravenous, intraosseous)
• Tamponade - cardiac
• Give adrenaline every 3-5 min
• Toxins
• Correct reversible causes
• Tension pneumothorax
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<Is QRS narrow ( 0.12 sec)? Narrow Irregularw QRSm regular? Irregular Narrow Complex TachycardiaProbable atrial fibrillationControl rate with:• ß-Blocker or diltiazem• Consider digoxin or amiodarone if evidence of heart failureAnticoagulate if duration > 48h Seek expert helpNo Possible atrial flutter• Control rate (e.g. ß-Blocker)
Tachycardia(with pulse) • 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 signsSynchronised DC Shock*UnStablestable 1. Shock 2. SyncopeUp to 3 attempts 3. Myocardial ischaemia 4. Heart failure Broad• Amiodarone 300 mg IV over 10-20 min and repeat shock; followed by:• Amiodarone 900 mg over 24 h IrreguRegularRegularlarNarroBroad QRSIs rhythIs QRS regular? Seek expert help• 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?If Ventricular Tachycardia Possibilities include:(or uncertain rhythm):• AF with bundle branch block • Amiodarone 300 mg IV over 20-60 treat as for narrow complexmin; then 900 mg over 24 h• Pre-excited AF Yesconsider amiodaroneIf previously confirmed • Polymorphic VT SVT with bundle branch block:(e.g. torsades de pointes - • Give adenosine as for regular give magnesium 2 g over 10 min)narrow complex tachycardiaProbable re-entry PSVT:• Record 12-lead ECG in sinus rhythm• If recurs, give adenosine again & consider choice of anti-arrhythmic Attempted electrical cardioversion is always undertaken under sedation or general anaesthesiaprophylaxis
*
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Bradycardia
• Assess using the ABCDE approach
• Ensure oxygen given and obtain IV access
• Monitor ECG, BP, SpO ,record 12 lead ECG
2
• Identify and treat reversible causes (e.g. electrolyte abnormalities)
Assess for evidence of adverse signs:
1 Shock
Yes 2 Syncope No
3 Myocardial ischaemia
4 Heart failure
Atropine
500 mcg IV
Satisfactory
Yes
Response?
No
Risk of asystole?
• Recent asystole
Yes • Möbitz II AV block
• Complete heart block with broad QRS
• Ventricular pause > 3s
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* No
OR
• Transcutaneous pacing
Seek expert help Observe
Arrange transvenous pacing
* Alternatives include:
• Aminophylline
• Dopamine
• Glucagon (if beta-blocker or calcium channel
blocker overdose)
• Glycopyrrolate can be used instead of atropine