Question 19

College Answer

Basic Life Support

a)  No signs of life equals: unresponsiveness, not breathi.ng, not moviri.g normally.
Pulse check not required to commence CPR.
b)  The term" Rescue Breathing'' has replaced Expired Air resuscitation
c)  Compression ventilation ratio 30:2 for children & adults. d)  Same ratio regardless of number of rescuers
e)  Identifying the lower halfof sternum by visualizing the centre of chest, no
. need  to measure and remeasure                                .
f)  2 initial breaths, not 5.
g)  Chest compressions at 100 Imin

Advanced Life Support

.  a)  Minimise interruptions to chest compressions
b)  If unwitnessed arrest,  VF or pulseless VT,.single shock instead of stacked shocks.

c)  If witnessed arrest-up to 3 shocks may be given at the first attempt.

d)  If monophasic defibrillator-energy level360 J
e)  Ifbiphasic defibrillator-energy level200 J
f)   If unsure of device, use 200

J. After each defibrillation, 2 min of CPR before checking.pulse.

Discussion

Since the 2006 update (and this question), there has been another guideline update.

The below answer will be based on the most recent change, and thus is going to look different to the college answer from early 2007.

In summary:

Changes to BLS:

• "signs of life" changed into "unresponsive and not breathing normally"
• If unwilling to perform conventional CPR, public is encouraged to perform compression-only CPR
• Pulse check has been downgraded - it is now only for health care professionals
• "S" has been added into DRSABC - it stands for "send for help"
• CPR now commences with chest compressions rather than rescue breaths

Changes to ALS:

• Depth of compression increased to > 5 cm
• Now, we charge the defibrillator while chest compressions continue
• No longer are "stacked shocks" recommended (outside of "special circumstances")
• When amiodarone is given after the third shock, the timing is now "at the time of CPR recommencement"
• Atropine has been removed from the guidelines
• Precordial thump is no longer recommended for VF - monitored pulseless VT only
• Hyperoxia after ROSC is emphasised as a bad thing.

The ARC has a portion of their website dedicated to the past update information of their guidelines.

Specifically, one can review a summary of BLS changes and a summary of ALS changes.

The index of the new guidelines is available from the ARC website.