Birmingham Children’s Hospital ED Handbook Version 1 (2011)

(1.12) ADULT ADVANCED LIFE SUPPORT

Unresponsive?

Safety:
Approach with care; Free from danger
Stimulate:
Are you alright?
Shout:
For help

Airway opening
manoeuvres

Look, listen, feel

30 chest compressions

2 rescue breaths

Continue CPR Compression rate:

(30 compressions: 2 ventilations)
100 – 120 per minute

VF or Pulseless VT Asystole or PEA

Assess
SHOCKABLE rhythm NON-SHOCKABLE

Timings and sequence of
drugs and DC shocks is as
per paediatric algorithms
Adult Doses:
Adrenaline 1 mg IV (10 ml of 1:10,000)
Amiodarone 300 mg IV (in persistent VF/VT, a second dose
of 150 mg IV may be given)
Sodium bicarbonate 50 mmol IV (50 ml of 8.4% solution)
– in arrests associated with hyperkalaemia or TCA overdose
DC shock 150 J (BCH defibrillator)
Birmingham Children’s Hospital ED Handbook Version 1 (2011)
ACUTE CORONARY SYNDROMES

These include:
Unstable angina
Non ST-segment-elevation myocardial infarction
ST-segment-elevation myocardial infarction

1. Phone 999 (priority in these patients is rapid ambulance transfer to an adult unit with facilities for
reperfusion therapy)

2. Aspirin 300 mg PO (crushed or chewed) as soon as possible

3. Glyceryl trinitrate (GTN) 300 – 600 mg sublingually (spray or tablet), unless patient is hypotensive

4. Oxygen

5. IV Morphine (titrated to achieve analgesia)

NB. 12-lead ECG is not essential, as this will be performed and interpreted by the paramedic crew.

Reference
Resuscitation Council (UK) Guidelines 2010