As a free resource for our visitors, this page contains links to sample algorithms for the main AHA Advanced Cardiac Life Support cases. See our website terms. Compatible part number: , We now sell laminated pocket sized algorithm cards. Purchase Cardiac Arrest Algorithm This case presents the recommended assessment, intervention, and management options for a patient in respiratory arrest. The patient is unresponsive and unconscious.
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Perform continued assessment of airway patency while giving breaths. Have the person doing chest compressions pause during the 2 rescue breaths. If the patient is not ventilating well or if there is a presumed risk of aspiration, insert an advanced airway device when prudent: Endotreacheal Intubation is the preferred method.
View the advanced airway section Breathing Confirm correct placement of the advanced airway device: Look for condensation during exhalation. Look for equal bilateral chest rise. Confirming equal bilateral breath sounds with auscultation.
If incorrect placement: Remove the airway device, ventilate the patient using the ambu bag for a short period of time, and then reattempt placement.
If correct placement: Secure placement of the airway device. Continue to monitor: oxygenation saturation with pulse oximeter end-tidal CO2 Rescue breathing during CPR with an advanced airway: breaths per minute 1 breath every seconds Chest compressions should be given continuously at a rate of to per minute. Initiate therapy of ACLS algorithm corresponding with the identified heart rhythm.
Drug therapy, Electrical therapy, Pacing, etc. First, is the airway patent or obstructed. Second, is there possible injury or trauma that would change the providers method of treating an obstructed airway or inefficient breathing. The provider may also be able to hear or feel the movement of air from the patient.
A completely obstructed airway will be silent. An awake patient will lose their ability to speak, while both a conscious or unconscious patient will not have breath sounds on evaluation. The provider will also not feel or hear the movement of air. If the airway is partially obstructed snoring or stridor may be heard. Cervical Spine Injury? If the provider evaluates the patient to have an obstructed airway, intervention should take place. If the adverse event of the patient was witnessed and there is no reason to suspect a cercival spine injury, the provider should use the head tilt-chin lift maneuver to open the airway.
If neither technique works, attempt an advanced airway using inline stabilization. Brain Injury? The breathing center that controls respirations is found within the pons and medulla of the brain stem. If trauma, hypoxia, stroke, or any other form of injury affects this area, changes in respiratory function may occur. Some possible changes are apnea cessation of breathing , irregular breathing patterns, or poor inspiratory volumes.
If the breathing pattern or inspiratory volumes are inadequate to sustain life, rescue breathing will be required, and an advanced airway should be placed.
Oral Airway: Assure the artificial airway is the appropriate size for the patient. The airway should be easily inserted with a tongue blade. Avoid use in patients with an active gag reflex. Nasal Trumpet Airway: Best practice is to lube before insertion. Careful not to cause trauma to nasal mucosa results in bleeding. This is reasonably tolerated by patients with an active gag reflex.
Advanced Airways When you are unable to open airway using head tilt-chin lift or jaw thrust maneuvers. If you have difficulty forming a seal with the face mask. If the patient requiring continued ventilatory support. When the patient has a high risk for aspiration provide an ETT or Combitube. Remember, a patient should be unconscious or sedated without an active gag reflex before instrumentation of the airway occurs with an ETT, Combitube, or LMA.
Endotracheal Tube ETT Requires additional instrument for insertion laryngoscope, glidescope, fiberoptic. Laryngoscope blades average adult size : MAC 3 or 4, Miller 2 or 3. ETTs require mastery of technique for consistent appropriate placement. Average size of ETT for orotracheal intubation for adults is 7.
The ETT is placed into the trachea, having direct visualization of the vocal cords. Average depth of intubation:.
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