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ED ALS Competency assessment framework Critical Indicator coverage Module 1 Module 2 Module 3 Module 4 Current assessment of patient’s condition promotes prompt and appropriate intervention Identifies that a cardiac arrest has occurred X X X X X X X X Pt unresponsive and absent or abnormal breathing Initiates basic life support Demonstrates how to attach a defibrillator / cardiac monitor + how to operate the defibrillator in manual mode. X X Identification of normal and abnormal rhythms assist with the instigation of appropriate interventions and promotes patient safety SHOCKABLE RHYTHMS Demonstrates knowledge and understanding of the Advanced Life Support algorithm X X Recognises a shockable rhythm: X X X X X X X X X X Ventricular Tachycardia Ventricular Fibrillation Demonstrates management of shockable rhythms Pulseless Ventricular Tachycardia Ventricular Fibrillation Initiates single shock at 200j Lifepak (3 stacked shocks at 200j IN SPECIAL CIRCUMSTANCES) Demonstrates appropriate safety precautions when shocking prepares patients chest (clean & dry) removes patches, electrodes, things that may inhibit appropriate placement of pads places pads to STERNUM and APEX dials defibrillator to 200j Calls “STAND CLEAR” X ED ALS Competency assessment framework uses a firm, loud voice Visually checks the area, ensuring all staff and self are clear of the patient and bed Commences CPR immediately post shock X X X X Carotid Pulse check by trained providers is to take no longer than 10 seconds. Initiates single shock regime for subsequent shocks X X 30 compressions to 2 breaths Reassesses rhythm and pulse at the end of each two minute cycle (or 5 cycles of 30:2) NON-SHOCKABLE RHYTHMS Recognises non-shockable rhythms X Asystole PEA Idioventricular Sinus bradycardia Complete heart block Demonstrates management of non-shockable rhythms X X X X X X Immediate CPR for 2 minutes or 5 cycles of 30:2 Assesses pulse and rhythm at the end of each two minute cycle Knowledge of and demonstrated use of pharmacological therapy assists with the treatment of life threatening arrhythmias Demonstrates knowledge of the indications, dosages and method of administration of the following drugs Adrenaline X X X *Non-Shockable rhythm: 1mg immediately then every 3-5 minutes (alternate cycles of CPR) *Shockable rhythm: 1mg after second shock then every 35 minutes (alternate cycles of CPR) Amiodarone Recurrent/refractory VF or VT * 300mg in 20mls of 5% dextrose after the 3rd shock at the recommencement of CPR. A further dose of 150mg can be considered Other Drugs to be considered X X X ED ALS Competency assessment framework Calcium Chloride Sodium Bicarbonate Magnesium Sulphate Potassium Chloride Atropine States method of administration for the above medications: Given at the time of commencement of CPR/ IV or IO/ min 30 ml flush X X X X X X X X X X X Ongoing assessment facilitates patient management Identifies possible reversible causes X Hypoxia Hypovolemia Hypo/hyperthermia Hypo/hyperkalaemia & metabolic disorders Thrombosis – pulmonary / coronary Tamponade Tension pneumothorax Toxins / poisons / drugs Transcutaneous (External) Pacing Recognises necessity for transcutaneous pacing X X Haemodynamically unstable bradycardias nonresponsive to medical therapy Performing Pacing LIFEPAK X Turns monitor on & selects manual mode- check that is in Lead 2 or lead with clearest ECG trace Attaches monitoring leads to patient Applies Quick – Combo pacing pads Presses PACER Presses RATE to select desired pacing rate Presses CURRENT to start pacing and increase until electrical capture occurs check that mechanical capture has occurred (this is evident by a palpable pulse with each paced beat.) X DCCV Recognises necessity Ventricular Tachycardia with a pulse Tachyarrhythmia with compromise X X ED ALS Competency assessment framework Performs appropriately Synchronised Energy selection: 100-200J (3 attempts) Analgesia/sedation Demonstrates appropriate post resuscitation care X Verbalises appropriate post-arrest care X X X X Airway/ventilation : SaO2/pO2/ CO2 Circulation: BP Glucose Targeted Temperature management Specific management 12 lead ECG” ?STEMI Underlying cause: Electrolytes etc Disposition/transfer Communication with family Debriefs with staff Ceasing resuscitation Verbalises principles underlying/approaches to cessation of resuscitation X