A Textbook of Clinical Pharmacology and Therapeutics

and check that the chest falls between respirations. If avail-
able, 100% oxygen should be used.
Check for a pulse by feeling carefully for the carotid or
femoral artery before diagnosing cardiac arrest. If the arrest
has been witnessed, administer a single thump to the pre-
cordium. If no pulse is palpable, start cardiac compression
over the middle of the lower half of the sternum at a rate of
100 per minute and an excursion of 4–5 cm. Allow two breaths
per 30 chest compressions. Drugs can cause fixed dilated
pupils, so do not give up on this account if drug overdose is a
possibility. Hypothermia is protective of tissue function, so do
not abandon your efforts too readily if the patient is severely

hypothermic (e.g. after being pulled out of a freezing lake).

Mobilize facilities for active warming.

ADVANCED LIFE SUPPORT

Basic cardiopulmonary resuscitation is continued throughout as

described above, and it should not be interrupted for more than

10 seconds (except for palpation of a pulse or for administration

of DC shock, when personnel apart from the operator must

stand well back). ‘Advanced’ life support refers to the treatment

of cardiac dysrhythmias in the setting of cardiopulmonary

220 CARDIAC DYSRHYTHMIAS

*Reversible causes

Hypoxia Tension pneumothorax

Hypovolaemia Cardiac tamponade

Hypo/hyperkalaemia/other metabolic disturbance Toxins

Hypothermia Thrombosis (coronary or pulmonary)

Unresponsive?

Open airway

look for signs of life

Call

resuscitation

team

CPR 30:2

Until defibrillator/monitor attached

Assess

rhythm

Shockable

(VF/pulseless VT)

Non-shockable

(pulseless electrical

activity/asystole)

1 Shock

150–360 J biphasic or

360 J monophasic

Immediately resume:

CPR 30:2

for 2 min

Immediately resume:

CPR 30:2

for 2 min

During CPR:

• Correct reversible causes*


• Check electrode position and
  contact


• Attempt /verify:
  i.v. access
  airway and oxygen


• Give uninterrupted
  compressions when airway secure


• Give adrenaline every 3–5 mins


• Consider: amiodarone, atropine,
  magnesium

Figure 32.2:Adult advanced life support.

(Redrawn with permission from the

European Resuscitation Council

Guidelines, 2005.)