This document appears to be an assessment checklist for responding to a medical emergency. It lists various actions and roles divided into categories like danger, response, airway, breathing, circulation, defibrillator, drugs, and reversible causes. For each item it indicates whether the task was completed by the first responder, airway role, circulation role, defibrillator role, drug role, or team leader and provides space to check off whether the task was assessed, treated or not applicable.
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1.
Assessment
Item
1
0
NA
Danger
1st
Responder
Environment
Patient
Situation
Response
1st
Spontaneous
Responder
Voice
Pain
Send
for
help
1st
Responder
Emergency
call
Phone
for
help
Airway
Airway
Role
Assess
airway
Clear
airway
–
suction
Airway
manoeuvre
Airway
adjunct
Breathing
Airway
Role
Look
for
chest
rise/fall
Listen
for
air
entry
Feel
for
breath
Circulation
Circulation
Role
CPR
per
BLS
Pulse
Check
for
ALS
IV/IO
Access
Obtained
Time
to
CPR:
mins
Defibrillator
Defib
Role
Connect
defib
pads
Assess
rhythm/pulse
Shock
at
200J
if
VT/VF
Time
to
shock:
mins
Drugs
Drug
Role
Adrenaline
1mg
PEA
=
Immediately
VF/VT
=
Post
2nd
shock
Amiodarone
300mg
VF/VT
=
Post
3rd
shock
Reversible
Causes
Team
Leader
&
Team
Hypoxia
• Assess
• Treat
Hypovolemia
• Assess
• Treat
Hypo/Hyper
K
&
Metabolic,
BGL
• Assess
• Treat
Hypo/Hyperthermia
• Assess
• Treat
Tension
Pneumothorax
• Assess
• Treat
Tamponade
• Assess
• Treat
Toxins
• Assess
• Treat
Thrombus
• Assess
• Treat
Total
Score
=
Adult
ALS
Score
Global
Ratings
of
Team
Performance
Never
Rarely
Occasionally
Frequently
Always
Effective
Airway
Maintained
1
2
3
4
5
(BVM
+/-‐
LMA/ETT)
Effective
CPR
Maintained
1
2
3
4
5
(rate/depth
rotation
2mins)
Adhered
to
ALS
Algorithm
1
2
3
4
5
(2
minute
cycles)
Clear
Team
Roles
1
2
3
4
5
Communication
Effective
1
2
3
4
5
(closed
loop)
Effective
transition
to
Post
1
2
3
4
5
Resus
Care