Advanced Life Support (ALS) Level 3 (VTQ)
Course Content
- ALS Introduction
- Initial Care and PPE
- Pre-shift checks
- Privacy and Dignity
- Chain of infection and universal precautions
- How to use gloves
- Scene safety
- Primary Survey
- National Early Warning Score - NEWS2
- NEWS2 Escalation
- Chain of Survival
- Chain of communication
- When communication breaks down
- Respiration and Breathing
- Pulse Points
- Recovery Position
- Infant Recovery Position
- ABCDE Approach
- Heart Rhythms
- Airway Management
- ECG's
- Pulse Oximetry
- Pharmacology ,Drugs and Medications
- Advanced CPR
- Non-traumatic chest pain
- First Aid vs BLS Healthcare Professionals
- When to call for assistance
- Advanced CPR Overview
- CPR Introduction
- Adult CPR Theory
- Ethics of resuscitation
- Bag Valve Masks
- Pocket Mask - Advanced
- Adult CPR
- CPR Breaths
- Compression only CPR
- CPR Seizures and agonal gasps
- Using an AED
- AED Pad Placement
- CPR Cycle - 1 person
- Effective CPR
- Improving compressions
- The Precordial thump
- Improving breaths
- The hospital resuscitation team
- Child and infant CPR overview
- Infant CPR practical (first aid guidelines)
- Child and infant CPR Theory
- Post resuscitation care
- Defibrillation
- Oxygen
- When Oxygen is Used
- Hazards of using oxygen
- Contra Indications Of Oxygen
- Oxygen and COPD
- Hypoxia
- Storage Of Oxygen
- Transport of Cylinders
- Standard oxygen cylinder
- PIN INDEX cylinder
- Oxygen Regulators
- BOC Oxygen Kit
- How long does an Oxygen cylinder last?
- Oxygen Giving Set
- Venturi Mask
- Non Rebreather mask
- Nasal Cannula
- DNR's and When to Stop Resuscitation
- CPR Scenarios
- Choking
- Medical Emergencies
- ALS Summary
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So what we are going to look at now is breaking CPR down into its separate parts. The first thing we are always going to do, we check for dangers. Well, we are in the back of an ambulance for this filming so there should not be any dangers, but there might be, we have got oxygen and all sorts of stuff in here that we need to be careful of. But if you are in any other environment, danger comes first. My safety is critically important because, without me, the patient has not got a chance of survival if there is nobody else around. So, safety comes first, so we check for dangers. If there are no dangers, we then talk and tap, shout and shake to try and get a response. All we are trying to do is to rouse the patient. So once we have tried to get a response from the patient, the next thing we are going to do is check the airway. So we look inside the airway to look for things like forced teeth or anything that might be blocking the airway, liquids, fluids, vomit, blood, anything that might give us an airway problem. Once we are okay with that, the next thing we are going to do is a head tilt, chin lift, but first we are going to drop the stretcher flat, we are going to roll a blanket onto the neck, which will give us a natural position for the airway to open, and then we open the airway and check inside. Once we decided the airway is clear, we are going to look, listen and feel for no more than 10 seconds, listening for breath, feeling for breath on the face, watching the chest and feeling the chest rise and fall. No breathing, cardiac arrest. One thing we have to be careful of at this point is a thing called agonal gasping or agonal breathing. Agonal or agonal breathing is normally referred to as the last breaths of life. It is normally erratic, there is no pattern to it, it is deep and it is noisy sighing breaths. So they will expand the chest, take a large breath and normally groan at the same time. They may take two, three or four, there is no real set pattern to it, it is completely random deep sighing, noisy breaths. This is not breathing and quite often gets mixed up for breathing, the patient then gets put into a recovery position and unfortunately, CPR does not start and the patient's chance of survival drops dramatically. So be careful. Agonal gasping is important. The next thing that quite often happens to the patient initially in a cardiac arrest is the patient moves and people expect a dead still patient, no movement whatsoever. But it is not uncommon, in fact, it is very common, around 40% of all patients will move arms, they will move their limbs, they will twitch, they will shake, sometimes they will put both arms up above the head. Sometimes they will go vertical, but the patient will move, it is a natural reaction. It is a nerve stimulus to muscle creating spasm, creating movement. This one gets mixed up and confused for patients that are fitting. It is a hypoxic fit, it is lack of oxygen to the brain that is creating the stimulus, rather than an epileptic type fit created by nerve stimulus from brain activity. So this one is created by lack of oxygen stimulating the brain, whereas the other one can be created by numerous other reasons. Once we have eradicated both of those, we are now going to start CPR immediately. The faster we start, the better the outcome is going to be. So they are done very quickly following on the back of each shoulder, we identify the position, roughly nipple line, palm of the hand goes in the centre of the chest, roughly nipple line. The fingers are linked and the fingertips are placed onto the chest, the fingertips form a hinge, they are never going to move. Even though the hand lifts and lowers, the fingers do not come off position. That means we are always going to be doing compressions in exactly the same place every time. One problem that people get is they start to bounce all over the chest and you are never in the same place twice. The heart is not moving, so you should not be either. So once the position has been fixed, we fix the fingers to the chest directly over the top of the patient, arms straight, and we now compress the chest 5 to 6 cm in depth, and then we fully recoil by lifting the heel of the hand off the chest. What we are doing by doing that is we are squashing blood from the heart and then allowing it to fully recoil and refill. Every time we do a compression, we have to allow the refill. The rate of 120 per minute is giving us the best flow rate of blood up to the brain from the compression. So once we start, we continue with the compressions. Notice with the arms locked, I am not using muscle, I am using body weight. Notice my hand never changes position, the fingers are fixed and the compression to lift is regular rate. If we do this correctly, we get good quality blood flow to the brain, giving the patient a much better chance of survival.
Breaking Down CPR: Steps and Considerations
1. Ensuring Safety First
Prioritizing Safety in CPR
- Assess for Dangers: Always begin by checking for potential hazards in the environment.
- Importance of Safety: Emphasize the critical role of your safety in ensuring the patient's chance of survival.
2. Seeking a Response
Efforts to Rouse the Patient
- Talk and Tap: Attempt to elicit a response from the patient through verbal communication and gentle physical stimuli.
3. Assessing the Airway
Evaluating and Clearing the Airway
- Airway Examination: Inspect the patient's airway for potential obstructions such as foreign objects, liquid, vomit, or blood.
- Utilizing Head Tilt, Chin Lift: Deploy the head tilt and chin lift technique after positioning the patient's stretcher flat.
- 10-Second Airway Check: Observe, listen, and feel for any signs of breathing or airway blockage for no more than 10 seconds.
- Beware of Agonal Gasping: Recognize and distinguish agonal gasping (last breaths) from normal breathing.
- Muscle Movements: Acknowledge that some patients may exhibit limb movements, often mistaken for seizures, due to lack of oxygen stimulation.
4. Initiating CPR
Commencing Cardiopulmonary Resuscitation
- Immediate CPR: Initiate CPR promptly for the best possible outcome.
- Proper Hand Placement: Position your hands over the chest, approximately at the nipple line.
- Compression Technique: Maintain consistent hand and finger placement, utilizing body weight for compressions.
- Compression Depth: Compress the chest to a depth of 5 to 6 cm, ensuring full recoil for blood refill.
- Compression Rate: Maintain a rate of 120 compressions per minute for optimal blood flow to the brain.
