Revising Your Protocols
These pictures illustrate concepts highlighted in the American Heart Association’s 2010 CPR Guidelines. Several AHA algorithms are included, such as the adult and pediatric BLS algorithms and the adult cardiac arrest algorithms. Other concepts in applying the Guidelines are also highlighted, including IO access, importance of transporting to a PCI facility and bag-mask valve ventilation. Note: Full-size algorithms are available in the supplement PDF at www.jems.com/special/evolution-resuscitation.
BLS and ACLS Providers
BLS and ACLS providers, upon arrival, should work as a team to rapidly assess the victim for responsiveness, normal breathing and a pulse. Note: Gasping is NOT normal breathing. Photo Ryche Guerrero
Traditional adult BLS algorithm
The 2010 Guidelines stress the importance of high-quality CPR. Aim for a compression rate of at least 100/min. and a depth of at least 2 inches. Photo Keith Cullom
As with adults, CPR in children and infants should begin with chest compressions, rather than rescue breaths. Lone rescuers should continue CPR with a compression-to-ventilation ratio of 30:2 and teams of two or more healthcare providers should continue with a ratio of 15:2. Photo Chris Swabb
Attempting to place an endotracheal tube can cause an interruption in the performance of chest compressions. If the patient can be effectively ventilated with a bag mask, consider delaying endotracheal intubation attempts. Photo Keith Cullom
Pediatric BLS algorithm
The linear Adult ACLS algorithm is similar in form to previous versions.
The new Adult ACLS circular algorithm emphasizes the cyclical nature of action and reassessment.
Adult bradycardia algorithm
IO cannulation provides quick access to the vascular space through the medullary cavity of the bone. All resuscitation drugs normally administered through an IV line can be administered through an IO line. Photo Lee Gillum
Adult tachycardia algorithm
Transport to PCI Facility
If the patient has a STEMI on their ECG, it’s reasonable to transport the patient directly to a PCI facility, bypassing closer EDs as necessary as long as that will facilitate achieving a time interval between first medical contact and inflation of the PCI balloon of less than 90 minutes. Photo Ryche Guerrero
In the 2010 Guidelines, pulse oximetry is noted as essential for proper monitoring of the post-resuscitation status of patients of all ages. Photo Craig Jackson
EMS Airway Clinic