european

resuscitation
council

Basic Life Support &

Automated External Defibrillation
Check response
Shake gently
Ask loudly: Are you all right?

If not responsive
Open airway & check for breathing

If not breathing normally

or not breathing

If breathing normally

Call 112, find & bring an AED

Start CPR immediately

*
Turn into recovery position

Place your hands in the centre of the chest

Deliver 30 chest compressions:

Call 112
Continue to assess that breathing
remains normal

Press firmly at least 5 cm deep

at a rate of at least 100/min
Seal your lips around the mouth
Blow steadily until the chest rises
Give next breath when the chest falls
Continue CPR

CPR 30:2

Switch on the AED & attach pads

Follow the voice prompts immediately
Attach one pad below the left armpit
Attach the other pad below the right collar bone, next to the breastbone
If more than one rescuer: dont interrupt CPR

Stand clear & deliver shock

Nobody should touch the victim
- during analysis
- during shock delivery

If the victim starts to wake up: to move, to open eyes and to breathe normally, stop CPR.
If still unconscious, turn him into the recovery position*.
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Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_BLSAED_01_01_ENG Copyright European Resuscitation Council

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In-hospital Resuscitation
Collapsed/sick patient

Shout for HELP

& assess patient

If NO signs of life

If signs of life

Call resuscitation team

Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access

CPR 30:2
with oxygen and airway adjuncts

Call resuscitation team

If appropriate

Apply pads/monitor
Attempt defibrillation
if appropriate

Handover to
resuscitation team

Advanced Life Support

when resuscitation team arrives
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Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_IHBLS_01_01_ENG Copyright European Resuscitation Council

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In-hospital Resuscitation
Collapsed/sick patient
Shout for HELP & assess patient

No

Call resuscitation team

Signs of life?

Yes

Assess ABCDE
Recognise & treat
Oxygen, monitoring, iv access

CPR 30:2

with oxygen and airway adjuncts

Apply pads/monitor
Attempt defibrillation if appropriate

Advanced Life Support

when resuscitation team arrives

Call resuscitation team

If appropriate

Handover to resuscitation team

www.erc.edu | info@erc.edu | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_IHBLS-A_01_01_ENG Copyright European Resuscitation Council

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Advanced Life Support

Universal Algorithm
Unresponsive?
Not breathing or only occasional gasps

Call
Resuscitation Team
CPR 30:2
Attach defibrillator/monitor
Minimise interruptions

Assess
rhythm

Shockable
(VF/Pulseless VT)

1 Shock

Immediately resume:
CPR for 2 min
Minimise interruptions

Non-shockable
(PEA/Asystole)

Return of
spontaneous
circulation

Immediate post cardiac

arrest treatment
Use ABCDE approach
Controlled oxygenation and
ventilation
12-lead ECG
Treat precipitating cause
Temperature control /
therapeutic hypothermia

Immediately resume:
CPR for 2 min
Minimise interruptions

During CPR

Reversible causes

Ensure high-quality CPR: rate, depth, recoil

Plan actions before interrupting CPR
Give oxygen
Consider advanced airway and capnography
Continuous chest compressions when advanced airway in place
Vascular access (intravenous, intraosseous)
Give adrenaline every 3-5 min
Correct reversible causes

Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Thrombosis
Tamponade - cardiac
Toxins
Tension pneumothorax

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_ALS_01_01_ENG Copyright European Resuscitation Council

european
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Advanced Life Support

Bradycardia Algorithm
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)

Yes

Assess for evidence of adverse signs:

1 Shock
2 Syncope
3 Myocardial ischaemia
4 Heart failure

No

Atropine
500 mcg IV

Satisfactory
Response?

Yes

No
Yes

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*

Risk of asystole?
Recent asystole
Mbitz II AV block
Complete heart block with broad QRS
Ventricular pause > 3s

No

OR
Transcutaneous pacing

Seek expert help

Arrange transvenous pacing

Observe

* Alternatives include:
Aminophylline
Dopamine
Glucagon (if beta-blocker or calcium channel
blocker overdose)
Glycopyrrolate can be used instead of atropine

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_ALS-BRAD_01_01_ENG Copyright European Resuscitation Council

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Advanced Life Support

Tachycardia Algorithm
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)

Synchronised DC Shock*

Unstable

Up to 3 attempts

Amiodarone 300 mg IV over

10-20 min and repeat shock;
followed by:
Amiodarone 900 mg over 24 h

Irregular

Assess for evidence of adverse signs

1. Shock
2. Syncope
3. Myocardial ischaemia
4. Heart failure

Is QRS narrow (< 0.12 sec)?

Stable

Broad

Narrow

Broad QRS
Is QRS regular?

Narrow QRS
Is rhythm regular?

Regular

Use vagal manoeuvres

Adenosine 6 mg rapid IV bolus;
if unsuccessful give 12 mg;
if unsuccessful give further 12 mg.
Monitor ECG continuously

Seek expert help

Possibilities include:
AF with bundle branch block
treat as for narrow complex
Pre-excited AF
consider amiodarone
Polymorphic VT
(e.g. torsades de pointes give magnesium 2 g over 10 min)

*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia

Regular

If Ventricular Tachycardia
(or uncertain rhythm):
Amiodarone 300 mg IV over
20-60 min; then 900 mg over 24 h
If previously confirmed
SVT with bundle branch block:
Give adenosine as for regular
narrow complex tachycardia

Normal sinus rhythm restored?

Irregular

Irregular Narrow Complex

Tachycardia
Probable atrial fibrillation
Control rate with:
-Blocker or diltiazem
Consider digoxin or amiodarone
if evidence of heart failure
Anticoagulate if duration > 48h

No

Seek expert help

Yes

Probable re-entry PSVT:

Record 12-lead ECG in sinus rhythm
If recurs, give adenosine again &
consider choice of anti-arrhythmic
prophylaxis

Possible atrial flutter

Control rate (e.g. -Blocker)

www.erc.edu | info@erc.edu | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_ALS-TACH_01_01_ENG Copyright European Resuscitation Council

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Paediatric Basic Life support

Health professionals with a duty to respond

UNRESPONSIVE?

Shout for help

Open airway

NOT BREATHING NORMALLY?

5 rescue breaths

NO SIGNS OF LIFE?

15 chest compressions

2 rescue breaths
15 compressions
After 1 minute of CPR call national emergency number (or 112)
or cardiac arrest team
www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_PaedBLS_01_01_ENG Copyright European Resuscitation Council

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Paediatric Life Support

Advanced Life Support
Unresponsive?
Not breathing or only occasional gasps

CPR (5 initial breaths then 15:2)

Attach defibrillator/monitor
Minimise interruptions

Call Resuscitation
Team
(1 min CPR first, if alone)

Assess
rhythm

Shockable
(VF/Pulseless VT)

1 Shock 4 J/Kg

Immediately resume:
CPR for 2 min
Minimise interruptions

Non-shockable
(PEA/Asystole)

Return of
spontaneous
circulation

Immediate post cardiac

arrest treatment
Use ABCDE approach
Controlled oxygenation and
ventilation
Investigations
Treat precipitating cause
Temperature control
Therapeutic hypothermia?

Immediately resume:
CPR for 2 min
Minimise interruptions

During CPR

Reversible causes

Ensure high-quality CPR: rate, depth, recoil

Plan actions before interrupting CPR
Give oxygen
Vascular access (intravenous, intraosseous)
Give adrenaline every 3-5 min
Consider advanced airway and capnography
Continuous chest compressions when advanced airway in place
Correct reversible causes

Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Tension pneumothorax
Toxins
Tamponade - cardiac
Thromboembolism

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_PALS_01_01_ENG Copyright European Resuscitation Council

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At all stages ask: Do you need HELP?

Newborn Life Support

Dry the baby

Birth

Assess (tone),
breathing and heart rate

30 sec

Remove any wet towels and cover

Start the clock or note the time

If gasping or not breathing

Open the airway
Give 5 inflation breaths
Consider SpO2 monitoring

60 sec

Re-assess
If no increase in heart rate
Look for chest movement

If chest not moving

Recheck head position

Consider two-person airway control
or other airway manoeuvres
Repeat inflation breaths
Consider SpO2 monitoring
Look for a response

Acceptable
pre-ductal SpO2
2 min: 60%
3 min: 70%
4 min: 80%
5 min: 85%
10 min: 90%

If no increase in heart rate

Look for chest movement

When the chest is moving

If the heart rate is not detectable or slow (< 60)

Start chest compressions
3 compressions to each breath

Reassess heart rate

every 30 seconds
If the heart rate is not detectable or slow (< 60)
Consider venous access and drugs

www.erc.edu | info@erc.edu
Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium
Product reference: Poster_10_NLS_01_01_ENG Copyright European Resuscitation Council