ACLS is geared towards healthcare professionals who either direct or participate in the management of cardiopulmonary arrest or other cardiovascular emergencies or personnel in emergency response. Upon successful completion of the course, students receive a course completion card, valid for two years.
Advanced cardiac life support (ACLS) is a group of procedures and techniques that treat immediately life-threatening conditions, including cardiac arrest, shock, stroke, and trauma. ACLS procedures and techniques are arranged into algorithms. Algorithms are a set of standard guidelines that improve the speed, effectiveness, and outcomes of ACLS. The goal of ACLS is to stabilize your condition. This includes restoring normal vital signs and alertness. ACLS and other types of intensive medical care save lives. ACLS generally does not reverse or cure an underlying end-stage or life-threatening condition. It is not successful in all cases. Do-not-resuscitate (DNR) options that do not use ACLS may be appropriate in some cases, such as in end-stage cancer. Discuss all end-stage disease treatment options with your doctor to understand which choices are best for you or your family member. You can specify your choices ahead of time. Types of ACLS treatments Some conditions and diseases require
A team of specially trained healthcare providers performs advanced cardiac life support (ACLS). ACLS teams generally include doctors, nurses, and respiratory therapists. The following doctors perform advanced cardiac life support (ACLS): Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. Cardiologists specialize in the medical treatment of heart disease. Critical care medicine doctors specialize in the diagnosis and management of life-threatening conditions. Emergency medicine and trauma doctors specialize in rapidly diagnosing and treating acute illnesses, conditions, injuries, and complications of chronic diseases. Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs, and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
Immediate
- Presumption: Out-of-hospital cardiac arrest with minimal resources
- Check pulse, if pulseless
- Begin CPR
- Attach monitor/defibrilator
- Rhythm shockable?
- Give oxygen if available
- Definitive treatment is transferred to the nearest emergency department
V-Fib and Pulseless V-Tach (Shockable)
ACLS Algorithm
- Shock as quickly as possible and resume CPR immediately after shocking
- Biphasic – 200J
- Monophasic – 360 J
- Give Epinephrine 1mg if (shock + 2min of CPR) fails to convert the rhythm
- Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
- 1st line: Amiodarone 300mg IVP with a repeat dose of 150mg as indicated
- 2nd line: Lidocaine 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min
- Polymorphic V-tach: Magnesium 2g IV, followed by a maintenance infusion
Asystole and PEA (Non-Shockable)
- Epinephrine 1mg q3-5min
Mechanism of PEA
- Three major mechanisms of PEA (3 & 3 Rule)
- Severe Hypovolemia (or dehydration in athletes)
- Obstruction
- Tension pneumothorax
- Cardiac tamponade
- Massive Pulmonary embolism
- Pump Failure
Treatable ACLS Conditions (H’s and T’s)
- Hypovolemia
- Hypoxemia
- Hydrogen ion (i.e. severe acidemia)
- Hypokalemia/Hyperkalemia
- Hypothermia/Heat Stroke
- Tension Pneumothorax
- Cardiac Tamponade
- Toxicology including Performance Enhancing Drugs
- Thrombosis, pulmonary
- Acute Coronary Syndrome
PEA Evaluation by QRS
A differential based on QRS being narrow or wide and aided by ultrasound
QRS Narrow
- Mechanical RV Problem – Ultrasound should show hyperdynamic LV and potential cause
- Cardiac Tamponade
- Tension Pneumothorax
- Deterioration after intubation
- Pulmonary Embolism
- Acute Coronary Syndrome
QRS Widened
- Metabolic LV Problem – Ultrasound should show hypokinetic LV
- Hyperkalemia
- Sodium-channel blocker toxicity (Ex. Tricyclic (TCA) toxicity)
- Agonal rhythm
- Acute Coronary Syndrome
General
- A: Adjunct – Place oropharyngeal airway
- B: Breathing – Attach to bag valve mask (BVM)
- C: Compressions – Switch out providers q pulse check (ever 2 minutes)
- D: Defibrillation
- May be ok to shock during compressions if wearing gloves and using biphasic device[1]
- Precharge prior to pulse & rhythm check to increase overall compression time
- E: Exposure
- Other
- Consider placing IO if unable to obtain IV access
- Use ultrasound to evaluate for possible correctable etiologies
