Advanced Life Support (ALS)

Assesses for danger	0	1	2
Stabilises C-spine using hands or 3 point fixation if possible (Assesses for collar size use finger breadths from angle of jaw to trapezius)	0	1	2
Checks for response (AVPU)	0	1
Shouts for help	0	1
Assesses airway for obstruction and either head tilt chin lift or jaw thrust in cases of suspected c-spine injury	0	1
Uses McGill’s forceps or Yanker sucker to remove any obstruction	0	1
Looks, listens and feels for breathing (10 secs) whilst feeling carotid pulse	0	1
Comments if in respiratory or cardiac arrest	0	1
Calls crash team with location, patient gender and status and requests defibrillator	0	1
In case of respiratory arrest, ventilates with the Bag-Valve-Mask at 10-12 breaths/min and checks pulse every minute	0	1	2
In cardiac arrest, begins chest compressions (heel of hand, midpoint of xiphisternum and jugular notch, 100-120/minute, 30 compressions: 2 breaths)	0	1	2
When crash team arrives, takes charge as first on scene	0	1
Continues compressions whilst asking for someone to replace you so you can direct the team	0	1
Priority to turns defibrillator on to lead 2 and attach pads	0	1
Attaches pads below right clavicle and in the mid axillary line at V6	0	1
States that one person should secure airway and maintain ventilation to allow for uninterrupted compressions. This should be checked by auscultating the chest without interrupting compressions	0	1
States that one person should introduce two grey wide bore cannulas	0	1
States that one person should be on reserve for compressions to switch as person doing compressions tires	0	1
States that two people should be responsible for doing a 3 point pulse check (one carotid, two femorals)	0	1
Team should begin to assess for reversible causes of arrest	0	1
Assures compressions paused very briefly to assess rhythm. Person should be on standby to immediately resume compressions	0	1
If non-shockable rhythm (asystole or PEA), continues chest compressions and gives 1mg 1 in 10,000 adrenaline then reassess rhythm after each cycle of compressions lasting 2 minutes and gives adrenaline on every alternate cycle (1,3,5,7 etc.)	0	1	2
If shockable rhythm (VF or VT), continue compressions whilst waiting for machine to charge. Once charged make sure top, head, bottom and oxygen clear before administering biphasic shock then continues compressions for 2 minutes and reassesses (for pulse, rhythm and other signs of life indicating return of spontaneous circulation or ROSC)	0	1	2
After 3rd shock in shockable rhythm, gives adrenaline and amiodarone 300mg and then adrenaline only every alternative cycle (3,5,7,9 etc)	0	1
States reversible causes of cardiac arrest and treatment (4H and 4T)	0	1
Hypoxia [15L of 100% oxygen by NRBM], Hypothermia [bear huggers], Hypo/hyperkalaemia [IV calcium chloride in case of hyperkalaemia], Hypovolaemia [IV fluids + surgery]	0	1	2
Tension pneumothorax [thoracocentesis, chest drain], Cardiac tamponade [pericardiocentesis], thrombus [thrombolytics], toxins [supportive + antidotes]	0	1	2
If return of spontaneous circulation achieved, assesses ABCD, takes 12 lead ECG, monitors observations, checks blood glucose. Continues to identify causes and transfers patient to ICU. Considers controlled ventilation and therapeutic hypothermia	0	1	2

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