Advanced life support (ALS)

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Cardiac

• During CPR
• Ensure high quality chest compressions
• Minimise interruptions to compressions
• Give oxygen
• Use waveform capnography
• Continuous compressions when advanced airway in place
• Vascular access (intravenous or intraosseous)
• Give adrenaline every 3–5 min
• Give amiodarone after 3 shocks

• Treat reversible causes
• Hypoxia
• Hypovolaemia
• Hypo-/hyperkalaemia/metabolic
• Hypothermia/hyperthermia
• Thrombosis — coronary or pulmonary
• Tension pneumothorax
• Tamponade — cardiac
• Toxins

• Consider
• Ultrasound imaging
• Mechanical chest compressions to facilitate transfer/treatment
• Coronary angiography and percutaneous coronary intervention
• Extracorporeal CPR