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CPR Algorithm 2023 v0.1
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You’re thinking that adding a box to the top that says something like “unresponsive, apneic patient”? We decided to take that out because the algorithm is meant to be applied to patients believed to be in CPA as a reminder of the training the rescuers have already received. We thought that very basic aspect would be ok to leave off for simplicity’s sake. As a reminder, the intention of these cognitive aids is not to teach the algorithm exhuastively, but to serve as a cognitive aid for folks who have been trained. What do others think about the need for that box at the top? Great to get so many thoughtful suggestions!
I guess it goes back to what this flow chart is intended for. For me it gives an overview of the most important steps in the CPR process (as 1.0 version did well I think), not necessarily a more detailed broken down description of every step as it becomes less clear?
Good thoughts here. We were trying to address some of the issues that folks see to struggle with during in-person training, specifically the idea that compressions should be done while the defibrillator is charged and then AFTER the shock, a full 2 minute cycle of chest compressions should be done. Would love some more input on whether that’s clear on the left side of the algorithm and if there are suggestions for ways to make that clearer.
The new algorithm looks incredible! I can see how much thought has gone into making it very streamlined and clear while still fitting on a page for printing purposes.
The only issue is that the “Start BLS” is repeated every 2 minute cycle but “Start ALS” is only done once. This is why we pulled it off to the side in it’s own box that just terminates (i.e., doesn’t loop back to the main algorithm). We were concerned that having Start ALS in that same box and then looping the algorithm back to it would be confusing. Would love some more input on this.
BLS info should all be in 1 box so you don’t have to look elsewhere for the info. Pause and check should come after ALS, not along side. I think you have tried to indicate this by matching the red colour to ALS steps, but it needs to be clearer.
I suggest reformat this area to 3 wider boxes stacked vertically.
For small teams, there are times when all of the ALS initiation steps don’t get done before the end of the first 2 minute cycle, so we thought pulling that out to the side made sense so it didn’t get confusing (they should stop at 2 minutes). It’s also important that the CPR training will focus on teaching the algorithm, so although it is a bit complicated (as is CPR!), this is meant just as a reminder, not as something that would be used by folks who have not been trained in CPR. As for the BLS details, the issue is space on the algorithm and fitting everything in, but we could definitely look at widening that BLS box to pull the details in. We’ll send that suggestion to the graphic designer and see what she can come up with.
The only way to know if the first shock was unsuccessful would be to get to the end of the second cycle of BLS (after shocking at the end of the first) and then recheck the rhythm. The recommendation would be to shock a second time and then we suggest giving a dose of esmolol. It’s a little confusing, but is consistent with the esmolol recommendation. Let me know if that answers your question!
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I really like the suggested updates and appreciate the immense amount of work that goes into a project like this! At first glance here are my initial thoughts on the new algorithm.
1. I personally find the arrows difficult to follow sometimes. I do appreciate the difficulty of looping things back to an event so it something that will take getting used to.
2. The start BLS box 2 full minutes doesn’t lead my eye to the second BLS box but rather to the pause and check box which is telling me to make a rhythm diagnosis and palpate pulse but I haven’t started ALS which would have me putting on the ECG, ETCO2, IV, Reversal. I really like the 1.0 color coding of the algorithm and found that people found it to lock into as they progressed from BLS to ALS.
3. Is the question about diluting amiodorone being addressed? Is it to be given undiluted as a bolus or diluted per drug instructions and given as a bolus or given over 15 minutes? All questions that continue to be asked.
4.I am assuming there will be a major drug chart update as well with doses for Esmlol.
5. And finally,I am curious about the bicarb since the patient is already very acidotic and bicarb breaks down into CO2 and water, is this considered a Hail Mary because of the potential that the acidosis may worsen?
Again, incredible work and I am sure the final product will be outstanding. The quote I leave my students with “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” Change is good! Keep up the good work!
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