Preliminary First Actions

Airway, Breathing, Circulation & Defibrillation

Primary Survey

performed before the A of the primary

ABCD Survey
Assess responsiveness
Call for help fast

Secondary Survey

Appropriately position victim

Appropriately position rescuer

Airway, Breathing, Circulation and Defibrillation,1

18 APRIL 2011
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18 APRIL 2011
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Call For Help Fast

Assess Responsiveness

Non-traumatic cardiac arrest

? Trauma

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In a hospital
Outside a hospital
with a second rescuer
the lone rescuer
the lone rescuer with an AED
the lone rescuer with remote access
to a telephone

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18 APRIL 2011
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Appropriately Position The Victim

Appropriately Position The Rescuer

supine position
patient on the ground
? Cx spine injury
patient on bed / trolley

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18 APRIL 2011
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Primary ABCD Survey

Primary Survey
Focus on basic CPR and defibrillation

A.

Open the Airway

First A-B-C-D
Airway

: Open the airway

Breathing

: Look, Listen & Feel for breathing

Circulation

: Check pulse, start CPR

- head tilt, chin lift

- jaw thrust

Defibrillation : Attach ECG Monitor / defibrillator

- inspect for f.b., blood, vomitus
- clear all foreign objects
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B.

Assess Breathlessness
look, listen, feel

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ABCD Survey

nasopharyngeal airway

Ventilate patient
oral airway

- if nil
What manoeuvre to check for
obstructed airway

bag mask ventilation

If obstructed - how to clear it?

If ventilations needed, what
adjunts needed?
What rate and volume of
ventilation required?

pocket
face mask

Are ventilations adequate?

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18 APRIL 2011
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Secondary Survey

Primary ABCD Survey

C. Confirm Pulselessness
check carotid pulse
perform closed
chest compression
attach ECG monitor
hunt for VF / VT
D. Defibrillate, if appropriate

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Focus on intubation, IV. Access, rhythms, drugs and

reasons why cardiorespiratory arrest occurred

Second A-B-C-D
Airway
Breathing
Circulation
Differentials

Place advanced airway when expertise available

Confirm placement
Assess bilateral chest rise & ventilation
Gain access, determine rhythm, give appropriate
access
Search for, find & treat reversible causes

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18 APRIL 2011
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Secondary Survey
A.

Secondary Survey

Airway
Reassess adequacy of original airway
opening techniques

B.

Breathing
Check chest wall rises equally with ventilation

Assess need for endotracheal

intubation

Check if breath sounds equal

Verify preparation for ETT done

Confirm ETT placement

eg.- get tube of correct size

eg Esophageal detection device, ETCO2

- check ETT bulb

- lubricate lower portion of ETT

Add O2 - 100%

- ETT stylet
- check laryngoscope

Chest X-Ray

- prepare suction

Mechanical Ventilation

Intubate patient, if necessary

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18 APRIL 2011
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18 APRIL 2011
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Secondary Survey
C. Circulation

Secondary Survey
D.

Ante-cubital vein / external jugular vein

What caused the arrest?

Infusion fluid : Normal saline

Are there any reversible causes - those that

had a specific therapy?

Drugs administered via IV / IO / Central Line

Are there any complications of resuscitation

that have an immediately remediable cause?

Circulation time in cardiac arrest

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Differential Diagnosis

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18 APRIL 2011
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Universal / International ACLS Algorithm

Universal / International ACLS Algorithm

Assess
Assessrhythm
rhythm

Adult
AdultCardiac
CardiacArrest
Arrest
VF/VT
VF/VT

AA
BB
CC
DD

Primary
PrimaryABCD
ABCDSurvey
Survey
Focus
Focus: :Good
Goodquality
qualityCPR
CPRand
andEarly
EarlyDefibrillation
Defibrillation
Check
Checkresponsiveness
responsiveness
Activate
emergency
response
system
Activate emergency response system
Call
Callfor
fordefibrillator
defibrillator
Airway
Airway: :Open
Openthe
theairway
airway
Breathing
Breathing: :Look,
Look,Listen
Listen&&Feel
Feelfor
forbreathing
breathing
Circulation
:
Check
Circulation : Checkpulse,
pulse,start
startCPR
CPRwithin
within10s
10s
Defibrillation
Defibrillation: :attach
attachECG
ECGmonitor
monitor/ /defibrillator
defibrillator

Attempt
Attempt
defibrillation
defibrillationxx11
as
asnecessary
necessary

CPR
CPR
11- -22minutes
minutes

Analyse
Analyserhythm
rhythm

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Secondary
SecondaryABCD
ABCDSurvey
Survey
Focus
Focus: :more
moreadvanced
advancedassessments
assessments&&treatments
treatments
AAAirway
Airway
place
placeairway
airwaydevice
deviceas
assoon
soonas
aspossible
possible
BBBreathing
Breathing
confirm
confirmairway
airwaydevice
deviceplacement
placementby
byexamination
examination
(confirmation
(confirmationdevice
deviceisisrecommended)
recommended)
secure
secureairway
airwaydevice
device
confirm
effective
oxygenation
and
ventilation
confirm effective oxygenation and ventilation
CCCirculation
Circulation
establish
establishassess
assess- - IV
IV/ /IO
IO/ /Central
CentralLine
Line
identify
identify&&monitor
monitorrhythm
rhythm
administer
administerdrugs
drugsappropriate
appropriatefor
forrhythm
rhythm&&condition
condition
DDDifferential
DifferentialDiagnosis
Diagnosis
search
searchfor
for&&treat
treatidentified
identifiedreversible
reversiblecauses
causes

Non-VF/VT
Non-VF/VT

CPR
CPR
up
upto
to11- -22
minutes
minutes

Consider
Considercauses
causesthat
thatare
arepotentially
potentiallyreversible
reversible
Hypovolemia
Tablets
Hypovolemia
Tablets(drug
(drugOD,
OD,accidents)
accidents)
Hypoxia
Tamponade,
Hypoxia
Tamponade,cardiac
cardiac

Hydrogen
ion
acidosis

Tension
pneumothorax
Hydrogen
ion - acidosis
Tension pneumothorax
Airway, Breathing, Circulation
and Defibrillation,18
18 APRIL 2011 Hyper-/hypokalemia, other metabolic

Thrombosis,
coronary
Hyper-/hypokalemia, other metabolic
Thrombosis, coronary(ACS)
(ACS)
Airway, Breathing, Circulation and Defibrillation,18
Hypothermia
Thrombosis,
30 August 2001
Hypothermia
Thrombosis,pulmonary
pulmonary(embolism)
(embolism)