OK, you have completed your Advanced Life Support (ALS) and Basic Life Support (BLS) education.
Perhaps it was a few months back. Or perhaps you are due for a refresher.
And then your patient arrests. When you least are expecting it.
You immediately experience the arrest response mind donk.
Your brain is total beige…. and all your knowledge of the ALS algorithm seems to be folded up into an origami flapping bird that is migrating south to your sphincter.
I am going to give you a rough thought-script to simplify the whole thing and get you over any mental donk by moving you to move your nursing team through the things that need to be done.
This is NOT a substitute to the ALS pathway you have been taught, it is just a quick script to cover the first few minutes. By that time there should be plenty of assistance unfolding.
And…I am purposefully skipping over all the intermediate skills and interventions that need to be applied. A knowledge of BLS and ALS pathways is assumed.
Really, you know what to do.
It may have just been a while since you have had to access that part of your brain.
The purpose of this is to give you some solid waypoints, some goals to aim to reach quickly and effectively.
- A = Assemble (yourself and your team).
- B = BLS (yes or no)?
- C = Connect & Charge a defibrillator.
- D = Decide to shock.
- E = Every 2 minutes.
Assemble (yourself and your team).
Assemble yourself! Take a serious instant to wring the adrenaline out of your brain. ALS is easy.
Assemble your team. Yes, you are going to be checking for Danger and Responsiveness and whatnot, but your first waypoint is to have help at hand.
ALS is a team sport.
BLS (yes or no)?
When you undertake BLS and ALS courses, you are taught to assess airway, breathing, and circulation assessment and intervention respectively.
But the key decision point here is “Do I need to start BLS?”
Keep that in mind and move through your assessment swiftly to get to that point.
Then make the call.
If chest compressions are now in progress check that they are being delivered effectively. This is of great importance. If they are not, correct the technique or replace the person doing them.
Connect & Charge the defibrillator
Your next task is to have the patient connected to the defib.
Once it arrives, ensure that there is minimum disruption (i.e. nil) to chest compressions whilst the pads are applied.
Once pads are applied, turn the defib on1.
So again, you will:
- Continue BLS
- Call for a defibrillator.
- Connect the defibrillator.
- Charge the defibrillator.
It is a simple as BLS + Connect and Charge.
Decide to shock:
Now you are at your second decision point. Your first one was BLS yes or no.
The defib is connected and charged.
The rhythm is assessed.
The decision to shock is made.
I am not going to go through all the rhythms here, but to help narrow the options: if the monitor looks like normal ECG complexes or is a flat line, you are NOT going to shock.
If you are unsure what the rhythm is, ASK the team for help. If you are still unsure, recommence CPR until someone arrives who can identify the rhythm.
Do not shock.
- Sinus rhythm (PEA)
- Pulses VT.
Once this decision has been executed, BLS recommences immediately.
Every 2 minutes:
BLS now continues for 2 minutes without interruption until the defib is charged and the decision to shock is again made. Or until the patient lets you know that they are no longer appreciating CPR.
During this time you need to:
- Obtain and secure IV access.
- Draw up Adrenaline 1mg.
If you just shocked the patient it will be given after the NEXT shock. If you have not shocked your patient it will be given NOW.
- Maximise the airway and chest compression quality.
Consider adding airway adjuncts (naso/oropharyngeal).
Consider preparing to replace the person delivering CPR at the next rhythm check if they are fatigued.
There you have it. You are now well into the resuscitation. The donk has passed.
Hopefully the full team has arrived, is organised and following the cardiac-respiratory arrest algorithm by this stage.
HERE IT IS.