ALS 2 Handbook – References, Standards & Supporting Documents
Primary policy, standards, or other authority
Australian Resuscitation Council (ARC) http://www.resus.org.au/
International Liaison Committee on Resuscitation (ILCOR) http://www.ilcor.org
Australian Commission on Safety and Quality in Health Care. The National Safety and Quality Health Service (NSQHS) Standards. https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/
Consultation
Key stakeholders who contributed to and/ or reviewed this version include:
- Russell Gooch RN
- Barry McCarthy RN RP
- Paul Chant RP
- Elizabeth Bowell RN
- Dr Tim Jones
- Dr Anna Eakins RACGP
- Nathan Haynes CCP
References
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AHPRA (2020). Good medical practice: a code of conduct for doctors in Australia. https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx
Australian Resuscitation Council, (n.d). Any Attempt at Resuscitation is Better than No Attempt. https://resus.org.au
ARC (2009). ANZCOR Guideline 11.9 – Managing Acute Dysrhythmias. https://resus.org.au/the-arc-guidelines/
ARC (2011a). GUIDELINE 11.10 – Resuscitation in Special Circumstances. https://resus.org.au/the-arc-guidelines/
ARC (2011b). ANZCOR Guideline 11.3 – Precordia Thump and Fist Pacing. https://resus.org.au/the-arc-guidelines/
ARC (2015). ANZCOR Guideline 10.5 – Legal and Ethical Issues Related to Resuscitation. https://resus.org.au/the-arc-guidelines/
ARC (2016a). ANZCOR Guideline 11.6 – Equipment and Techniques in Adult Advanced Life Support. https://resus.org.au/the-arc-guidelines/
ARC (2016b). ANZCOR Guideline 11.6.1 – Targeted Oxygen Therapy in Adult Advanced Life Support. anzcor-guideline-11-6-1-targeted-oxygen-therapy-jan16.pdf
ARC (2016c). ANZCOR Guideline 11.7 – Post-resuscitation Therapy in Adult Advanced Life Support. The ARC Guidelines – Australian Resuscitation Council
ARC (2016d). ANZCOR Guideline 11.4 – Electrical Therapy for Adult Advanced Life Support. https://resus.org.au/the-arc-guidelines/
ARC (2016e). ANZCOR Guideline 11.5 – Medications in Adult Cardiac Arrest. https://resus.org.au/the-arc-guidelines/
ARC (2016f). ANZCOR Guideline 10.6 – Family Presence during Resuscitation. https://resus.org.au/the-arc-guidelines/
ARC (2016g). ANZCOR Guideline 11.10.1 – Management of Cardiac Arrest due to Trauma. https://resus.org.au/the-arc-guidelines/
ARC (2018). Guideline 11.2 – Protocols for Adult Advanced Life Support. The ARC Guidelines – Australian Resuscitation Council
ARC (2019a). ARC Guideline 11.1 – Introduction to and Principles of In-hospital Resuscitation. arc-guideline-11-1-introduction-to-and-principles-of-in-hospital-resuscitation-february-2019.pdf
ARC (2019b). GUIDELINE 11.10 – Resuscitation in Special Circumstances. https://resus.org.au/the-arc-guidelines/
ARC (2021a). ANZCOR Guideline 6 – Compressions. anzcor-guideline-6-compressions-apr-2021.pdf
ARC (2021b). Guideline 4 – Airway. The ARC Guidelines – Australian Resuscitation Council
ARC (2021c). Guideline 5 – Breathing. The ARC Guidelines – Australian Resuscitation Council
ARC (2021d). Guideline 6 – Compressions. The ARC Guidelines – Australian Resuscitation Council
Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281-2329. doi:10.1093/eurheartj/eht150
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Advanced Life Support Program
| Observed performance. | Observed | Not Observed |
| Demonstrated ABCDE patient assessment | ||
| Assesses the following using an organised approach: | ||
| A – Airway • VoiceBreath • sounds | ||
| B – Breathing • Respiratory rate • Chest wall movements • Chest percussion • Lung auscultation • Pulse oximetry | ||
| C – Circulation • Skin colour, warmth, and dryness • Capillary refill time • Pulse rate Heart auscultation • Blood pressure • Electrocardiography monitoring | ||
| D – Disability • Level of consciousness – AVPU (may use GCS) – AlertVoice responsive – Pain responsive – Unresponsive • Limb movements • Pupillary light reflexes • Blood glucose | ||
| E – Exposure • Skin observation for; bites, swelling, oedema, rashes • Temperature • Check drains, dressings, catheters, or pumps, IV lines. • Look in mouth and nose and any other relevant orifice. • Medications including medical patches | ||
| Observed performance. | ||
| Demonstrated patient assessment – Airway | Observed | Not observed |
| Demonstrates effective airway position management using: • Head tilt / chin lift • Jaw Thrust (suspected neck injury) | ||
| Demonstrates correct measurement and placement of: • Oropharyngeal airway • Nasopharyngeal airway | ||
| Demonstrates correct and effective use of Bag-Valve mask device. • 2-person bag valve mask • Demonstrated V – E grip (vice grip) | ||
| Discusses methods for clearing an obstructed airway. • Chest thrusts • Back blows | ||
| Discusses use and insertion and management of LMA and or I-gel. | ||
| Assesses ETT placement; (must know at least 3): • Equal rise and fall of chest. • Air entry via auscultation • End Tidal CO2Misting of tube • Direct visualisation during insertion | ||
| Applies correct rate and volume for ventilation of intubated patient receiving chest compressions: • Rate 6-10 bpm. • Volume for visual chest rise only, avoids hyperventilation | ||
| Demonstrates ability to apply supplemental oxygen: • BVM at 15 lpm oxygen for all patients receiving CPR. • Conscious patients who require resuscitation have oxygen applied to maintain sats between 94% – 98% • Conscious COPD patients who are CO2 retainers (Hypercapnic) have oxygen applied to maintain sats between 88% – 92% |
| Observed performance | Not | |
| Manual defibrillation | Observed | Observed |
| Correctly identifies lethal rhythms (VT, VF) | ||
| Demonstrates pad placement Anterior / Lateral | ||
| Correctly applies pads and demonstrates understanding of: • Clean dry skin • No jewellery • Not over Medication patches • 8 – 10 cm away from implanted defib / pacemaker • Ensures high quality BLS continues during pad placement | ||
| Demonstrates knowledge and ability to set energy level, • Default 200j • Increase to 360j for 2nd and every subsequent shock | ||
| Correctly applies defibrillation: • Utilises one-stop shock protocol, ensuring compressions continues while charging. • Selects correct energy. • Calls to remove oxygen. • Clears all rescuers except person doing chest compressions. • Charges defibrillator • When fully charged- pauses chest compressions to check rhythm. • Correctly identifies rhythm. • Confidently calls all clear • Performs safe visual sweep. • Safely applies defibrillation while watching environment for safety. • Adequately assesses accomplishment of defibrillation attempt (muscle twitch) • Immediately ensures CPR recommences without checking for rhythm. Demonstrates process for organised rhythm (i.e., dumps charge and checks for a central pulse |
| Observed performance. Monitored and witnessed arrest | Observed | Not Observed |
| Identifies need for 3 stacked shocks: Monitored witnessed arrest with a defibrillator immediately available. (Within 20 seconds, patient not centrally hypoxic as arrest cause) • Correctly applies pads.Selects correct energy (200j throughout) • Calls to remove oxygen. • Clears all rescuers. • Charges defibrillator • Confidently calls all clear • Performs safe visual sweep. • Safely applies defibrillation while watching environment for safety. • Adequately assesses accomplishment of defibrillation attempt (muscle twitch)Re-charges immediately and repeats up to 3 times in total if no change of rhythm. • Adequately assesses success of each defibrillation attempt (muscle twitch) • Safely dumps charge with a change to an organised rhythm. Commences CPR 10 seconds after the 3rd unsuccessful shock if nil change in rhythm |
| Observed performance. | Not Observed | |
| Demonstrated patient assessment. Cardioversion | Observed | |
| Correctly identifies narrow and broad complex tachycardias | ||
| Correctly identifies patient instability, necessitating need for cardioversion per algorithm | ||
| Demonstrate ability to plan for safe procedure: • Patient consent • Safe environment • Adequate staff | ||
| Identifies need for sedation | ||
| Identifies need for: • Expert help and medical order • Oxygenation • Pre procedure observations • Pathology | ||
| • Correctly applies pads. • Discusses pad placement options | ||
| • Selects appropriate energy. – Activates sync prior to cardioversion | ||
| • Correctly charges defibrillator. • Confidently calls all clear • Performs safe visual sweep. • Safely applies cardioversion. • Adequately assess success of defibrillation (muscle twitch) – Checks for rhythm change following shock | ||
| Re-engages sync between successive shock attempts | ||
| Correctly identifies narrow and broad complex tachycardias and seeks expert help |
| Observed performance | Not | |
| External Cardiac Pacing | Observed | Observed |
| Correctly Identifies brady-arrythmias. Seeks expert help | ||
| Gives examples and doses of recommended drug treatment. • Atropine sulphate • Adrenaline (epinephrine) IV infusion or micro bolus • Other alternative relevant drugs | ||
| Identifies need for external cardiac pacing for patient. If drug therapy ineffective • Correctly applies pads. • Selects appropriate rate. • Identifies successful capture. • Sets threshold above capture. • Checks for both electrical and mechanical capture | ||
| Demonstrates knowledge of pacing modes: • Demand • Non – demand | ||
| Demonstrates understanding of ongoing patient care: • Close continual observations • Frequent vital signs • Use of analgesia / sedation |