OT: New resus algorithm..

[Martyn]

I've just done my ALS update and noted that this year there are some significant changes to the annual update for both the ALS and BLS algorithm, most notable the ratio has changed from 15:2 to 30:2. There are other changes too. These changes were published by the resus council on 28th November 2005 (8 days ago), so unless you've had an update since then, you are likely to be out of date.

Stay current and check em out...

Adult Basic Life Support Algorithm & Guidelines

Adult Advanced Life Support Algorithm & Guidelines

For other related topics and more info, see the Resuscitation Council (UK) website.

 

[scanker]

Thanks for that - interesting reading.

 

[Martyn]

Thanks for that - interesting reading.

You're welcome. There are some significant changes this time round. Mainly the 30:2 ratio, but also the CPR should not be interrupoted for checking a pulse. The only indication for stopping CPR is the return of normal breathing.

 

[Buckshot]

Hmm interesting Martyn, thanks
I did my FAW refresher in Oct and nothing was mentioned about this. Just goes to show how quickly things can change.


What are Agonal gasps? Not heard of them before

Mark

 

[Martyn]

Hmm interesting Martyn, thanks
I did my FAW refresher in Oct and nothing was mentioned about this. Just goes to show how quickly things can change.

Trainers are still being told to teach the old algorithm untill they are up to speed with ther new one themselves.

What are Agonal gasps? Not heard of them before

Mark

We see it a lot in ICU, it's a very different from a normal breathing pattern. I found an excellent definition of it on the web which describes it very well...

Clinical death is often preceded (or its first evidences are accompanied) by a barely more than momentary period termed the agonal phase. The adjective agonal is used by clinicians to describe the visible events that take place when life is in the act of extricating itself from protoplasm too compromised to sustain it any longer. Like its etymological twin, agony, the word derives from the Greek agon, denoting a struggle. We speak of "death agonies," even though the dying person is too far gone to be aware of them, and even though much of what occurs is due simply to muscle spasm induced by the blood's terminal acidity. Agonal moments and the entire sequence of events of which they are a part can occur in all the forms of death, whether sudden or following upon a long period of decline into terminal illness, as in cancer.

 

[Buckshot]

Cheers Martyn, it's all silghtly less muddy now !!!

 

[Martyn]

Basically, when you are watching someone dying, they go through a few easily recognisable stages. They go from a pink colour, to very pale, to bluish-grey, there lips turn blue/grey and thier skin becomes very cold & clammy. At this point they may have a very weak pulse, but it is insufficient to get blood to all the bits that need it. They will be deeply unconcious, unarousable, and unaware of anything. As the CO2 rises in thier blood, they develop CO2 narcosis, which further deepens thier state of unconciousness. Thier breathing goes from regular, moderate breaths to slow short breaths, then to short gasps separated by several seconds - these are agonal gasps. It is not a breathing pattern that is adequate or compatible with life. It's more of a spasm than part of normal respiration. If you see someone doing this, they will soon be dead. Dont wait for that to happen, crack in and start CPR quick-smart.

 

[daveymonkey]

I take it that its the same ratio for intubated patients aswell? ve also heard that for defib its one shock at 360 joules, is that correct?

 

[Martyn]

I take it that its the same ratio for intubated patients aswell? ve also heard that for defib its one shock at 360 joules, is that correct?

No, tubed patients are continually bagged at a rate of about 15-20 breaths/min, without interruption over the top of continuous compressions at 100/min. CPR prior to intubation is 30:2 the same as the BLS algorithm in 2 minute cycles, with 1mg adrenaline every 3-5 minutes after the second shock if VF/PVT persists.

The defib shock depends on whether the unit is monophasic or biphasic, but yes, if we are talking the older monophasic, traditional defib with paddles, it's just one 360j shock every CPR cycle, rather than the old 200, 200, 360 routine.

For biphasic machines, the initial shock is 150-200j, then 150-360j every CPR cycle.