Hospital Life Support
and Automated External
Defibrillation
European Resuscitation
Council
www.erc.edu
LEARNING OUTCOMES
the student should be able to:Discuss the causes and prevention of
cardiorespiratory arrest
Discuss the role of the medical emergency
team (MET)
Demonstrate the ability to perform basic life
support
Identify rhythms that can be defibrillated
Show an awareness of drugs used in
cardiorespiratory arrest situations
Demonstrate the ability to perform hospital life
support, including the safe use of the
automated external defibrillator (AED)
HOW DOES HOSPITAL LIFE
SUPPORT DIFFER FROM
BASIC LIFE SUPPORT?
IDENTIFICATION OF PATIENTS AT RISK
PREVENTION OF CARDIORESPIRATORY
ARREST
ACCESS TO ADVANCED LIFE SUPPORT
- AED / DEFIBRILLATION
- ADMINISTRATION OF DRUGS
- AIRWAY ADJUNCTS
CAUSES AND PREVENTION OF
CARDIORESPIRATORY ARREST
AIRWAY OBSTRUCTION
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Blood
Vomitus
Foreign body
Direct trauma to face or throat
Central nervous system depression
Epiglottis
Pharangeal swelling
Laryngospasm
Bronchospasm
Bronchial secretions
CAUSES AND PREVENTION OF
CARDIORESPIRATORY ARREST
BREATHING INADEQUACY
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Chronic or acute
Continuous or intermittent
Respiratory drive
Respiratory effort
Cervical cord damage
Myasthenia gravis
Guillain-Barre Syndrome
Multiple sclerosis
Chronic malnourishment
CAUSES AND PREVENTION OF
CARDIORESPIRATORY ARREST
BREATHING INADEQUACY (CONT)

Pulmonary disorders
Pneumothorax
Haemothorax
Infection
Aspiration
Exacerbation of COPD
Asthma
Pulmonary embolus
CAUSES AND PREVENTION OF
CARDIORESPIRATORY ARREST
CARDIAC ABNORMALITIES

Primary
Directly involving the heart
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Ischaemia
Myocardial infarction
Secondary
The heart is affected by disease originating
elsewhere
IDENTIFYING PATIENTS AT RISK
OF CARDIORESPIRATORY
ARREST
Most people who suffer cardiorespiratory
arrest die
If patients can be identified before arrest,
lives will be saved
In approximately 80% of cases there is
deterioration in clinical signs before
cardiac arrest
MEDICAL EMERGENCY TEAM
Provide early access to expert medical
support
Have the ability to correct abnormalities
Can decrease overall mortality
The Chain of Survival
Early Access to emergency services or
cardiac arrest team
Out of hospital summon EMS
by dialling 999/112
In hospital call cardiac arrest
team ring 2222 (check
number when on placement)
External chest compressions and
ventilation will slow down the
rate of deterioration of the brain
and heart
Basic Life Support should be
performed immediately
Check safety
Check response
Shout for help
Tilt head back
Lift chin
Check for breathing
Raise the alarm
Pinch nose
Deliver two rescue breaths
Allow air to come out
Check for signs of a circulation
No signs of circulation
FIND CORRECT PLACE TO APPLY PRESSURE
COMMENCE CHEST
COMPRESSIONS
PRESS THE BREASTBONE 15 TIMES
FOLLOWED BY 2 BREATHS AND
CONTINUE
REVIEW OF CARDIAC
RHYTHMS
SINUS RHYTHM
SINUS TACHYCARDIA
SINUS BRADYCARDIA
ATRIAL FLUTTER
ATRIAL FIBRILLATION
VENTRICULAR FIBRILLATION
VENTRICULAR TACHYCARDIA
ASYSTOLE
PULSELESS ELECTRICAL ACTIVITY (PEA)
DRUGS USED IN
CARDIACRESPIRATORY
ARREST
OXYGEN
Given in the highest concentration
possible for all patients
EPINEPHRINE (ADRENALINE)
Is the first drug used in cardiac arrest from
any cause
It is given after each 3 minutes of CPR
Initial dose is 1mg
Increases cerebral and coronary perfusion
by vasoconstriction
ATROPINE
Used for asystole and pulseless electrical
activity with a rate of less than 60 per min
Recommend dose for adults is 3 mgs in a
single dose
Blocks the vagus nerve and increases
sinus automaticity
No evidence that it is effective in asystole
AMIODARONE
Used for refractory VF/VT and stable VT
and other tachyarrhythmias
If VT/VF persists after first 3 shocks
consider giving 300mgs
Prolongs QT intervals thereby slowing the
heart rate
OTHER DRUGS
MAGNESIUM SULPHATE
LIDOCAINE (LIGNOCAINE)
SODIUM BICARBONATE
CALCIUM
Chain of survival
The need for defibrillation
ventricular fibrillation:
80% of victims
survival decreases:
10% per minute
only treatment: electrical
defibrillation
this means: delivering
an electric shock with a
device called an
“Automated External
Defibrillator” (AED)
What is an AED?
a device that
delivers electric
shocks to victims
with cardiac
arrest
all AEDs share the same operating
principles
 self-adhesive defibrillation electrodes
 analyses the rhythm of the victim and
decides when a shock is needed
 accuracy is almost 100%
AED features
voice prompts
memory
analysing
ECG
Using an AED
 three steps:
1.decide to use
the AED
2.activate the
AED
3.follow
instructions
AED Example of Use
Switch on the AED
If NO signs of a
circulation
Attach the electrodes
Check for signs of a circulation
Follow directions
Analysis of the heart rhythm
ensure that
everyone is clear
during analysis
of the rhythm
If a shock is advised
ensure that
everybody is
clear
push shock
button
If no shock is advised
check for signs of a
circulation
if none present:
 start CPR
 continue CPR until the AED
tells you to stop

if signs of a circulation are
present (including normal
breathing):
 recovery position
 check regularly
Useful to know
wipe skin dry before attaching electrodes
shave or cut excessive hair: only if necessary!
remove plasters
place electrodes away from pacemakers
safety issues

risk to the rescuer

risk to the victim

risk to the bystanders
Equipment
face shield
face mask
Using a face mask
Checking the pulse
only if you feel
confident check the
carotid pulse otherwise
look for other signs of
circulation
Questions
?
Summary
Three steps:
1.
decide to use the AED
2.
activate the AED
3.
follow instructions
Summary
An AED delivers shocks to a victim in cardiac arrest
Use of an AED is safe and effective
First person at a cardiac arrest trained to use an
AED should do so