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    BCLS 2

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    Praveen Ravishankaran
    Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and focus on immediate CPR, defibrillation, and advanced medical treatment. Effective ACLS relies upon establishing an open airway, high-quality CPR, use of an AED, and administration of medications like epinephrine to treat shockable and non-shockable rhythms.

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    BCLS 2

    Uploaded by

    Praveen Ravishankaran
    70 views73 pages
    Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and focus on immediate CPR, defibrillation, and advanced medical treatment. Effective ACLS relies upon establishing an open airway, high-quality CPR, use of an AED, and administration of medications like epinephrine to treat shockable and non-shockable rhythms.

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    Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and focus on immediate CPR, defibrillation, and advanced medical treatment. Effective ACLS relies upon establishing an open airway, high-quality CPR, use of an AED, and administration of medications like epinephrine to treat shockable and non-shockable rhythms.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views73 pages

    BCLS 2

    Uploaded by

    Praveen Ravishankaran
    Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and focus on immediate CPR, defibrillation, and advanced medical treatment. Effective ACLS relies upon establishing an open airway, high-quality CPR, use of an AED, and administration of medications like epinephrine to treat shockable and non-shockable rhythms.

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    of 73

    ADVANCED CARDIAC LIFE

    SUPPORT(ACLS)

    Dr. Vipin Dev M


    Resident
    Bharathi Vidyapeeth Medical College
    ADVANCED CARDIAC LIFE SUPPORT

     Advanced cardiac life support or advancedcardiovascular


    life support (ACLS) refers to a set of clinical
    interventions for the urgent treatment of cardiac arrest
    and other life-threatening medical emergencies, as well
    as the knowledge and skills to deploy those interventions.
     ACLS is a series of evidence based responses simple
    enough to be committed to memory and recall under
    moments of stress.
     AMERICAN HEART ASSOCIATION (AHA) protocols are
    considered to be the GOLD standard ACLS protocols
     It gets reviewed every 5 year, now latest advancements in
    ecgguidelines.health.org
    IMPORTANCE OF BLS IN ACLS

     ACLS is built heavily upon the foundation of BLS


    AHA Adult Chain of Survival
    1. Immediate recognition of cardiac arrest and
    activation of the emergency response system
    2. Early CPR with an emphasis on chest
    compressions
    3. Rapid defibrillation
    4. Effective advanced life support
    5. Integrated post–cardiac arrest care
    AHA PEDIATRIC Chain of
    Survival
    COMPONENT OF HIGH QUALITY CPR IN BLS
     Scene safety:
    1. Make sure the environment is safe for rescuers and
    victim
     Recognition of cardiac arrest:
    1. Check for responsiveness
    2. No breathing or only gasping ( ie, no normal breathing)
    3. No definite pulse felt within 10 secs ( Carotid or femoral
    pulse)
    4. (Breathing and pulse check can be performed
    simultaneously within 10 secs)
    • Activation of emergency response system:
    If alone with no mobile phone, leave the victim to
    activate the emergency response system and get
    the AED before beginning CPR
    Otherwise, send someone and begin CPR
    immediately; use the AED as soon as it is
    available
    WITNESSED VS UNWITNESSED
    • WITNESSED
    • IF ALONE
    • ACTIVATE EMS
    • THEN CPR
    • IF 2 RESCUERS
    • START CPR
    • SECOND ONE – ACTIVATE EMS

    • UNWITNESSED
    • START CPR
    • GIVE FOR 2 MINS
    • ACTIVATE EMS
     Chest compression-
    Adult- 30:2
    Children or infant- 30:2 if one rescuer
    15:2 if more than one rescuer
     Compression rate:
    100-120/ min
     Compression depth:
    Adult- at least 5 cm
    Children or infant- at least 1/3rd AP diameter of chest
     Hand placement:
    Adult - 2 hands on the lower half of the sternum
    Children – 1 or 2 hands on the lower half of the sternum
    Infants – 2 fingers or 2 thumb defending of the number of
    rescuers
     Chest recoil:
    allow full recoil of chest after each compression; do not
    lean on the chest after each compression.
     Minimizing interruption: Limit interruptions in chest
    compressions to less than 10 secs.
    Adult advanced cardiovascular
    life support
    Shockable

    VT VF
    Monomorphic Fine or Coarse
    or polymorphic VF
    Ventricular tachycardia

    • .R-R interval usually regular, not always


    • QRS not preceded by p wave.
    • Wide and bizzare QRS.
    • Difficult to find seperation between QRS and T
    wave
    Rate=100-250bpm
    Torsades de Pointes

    Ttwisting of points, is a distinctive form of polymorphic ventricular


    tachycardia characterized by a gradual change in the amplitude
    and twisting of the QRS complexes around the isoelectric line.
    Rate cannot be determined.
    Ventricular fibrillation

    A severely abnormal heart rhythm (arrhythmia) that can


    be life-threatening.
    No identifiable P, QRS or T wave
    Emergency- requires Basic Life Support
    Rate cannot be discerned, rhythm unorganized
    Unshockable

    PEA- pulseless
    electrical activity or
    Asystole EMD-
    electromechanical
    dissociation
    Asystole

    a state of no cardiac electrical activity, hence no


    contractions of the myocardium and no cardiac
    output or blood flow.
    Rate, rhythm, p and QRS are absent
    Pulseless electrical activity

    • Pulseless electrical activity (PEA)


    • unresponsiveness and no palpable pulse
    • some organized cardiac electrical activity.
    • previously referred to as electromechanical
    dissociation
    Deliver single defibrillitor
    shock CPR-2 mins
    Check rhythm

    Deliver single shock- if VT


    /VF persist---CPR 2 mins
    Continue CPR 2 min and give EPINEPHRINE 1
    mg

    Amiodarone/ Lidocaine/ Magnesium sulfate

    Vt/ vf Defibrillate: Drug---Shock---Drug----


    Shock
    Asystole/PEA

    Identify and Continue


    Continue CPR (Intubate
    RX reversible CPR if
    and establish IV access)
    causes asystole/PEA
    Treatable Causes of Cardiac
    Arrest: The H’s and T’s
    H’s T’s

    • Hypoxia Toxins
    • Hypovolemia Tamponade (cardiac)
    • Hydrogen ion(acidosis) Tension pneumothorax
    • Hypo-/hyperkalemia Thrombosis, pulmonary
    • Hypothermia Thrombosis, coronary
    DEFIBRILLATION
    Defibrillation
    • Biphasic wave form: 120- 200 J
    • Monophasic wave form: 360 J
    • AED- device specific

    • Failure of a single adequate shock to restore a


    pulse should be followed by continued CPR and
    second shock delivered after five cycles of CPR
    HOW TO USE DEFIBRILLATOR
    SAFETY

    • If patient not intubated remove o2 delivery devices


    • If intubated either leave bag valve resuscitator
    attached to Et or remove it
    • If available use self adhesive defibrillation pads
    • Do not place over pacemakers
    • Remove transdermal patches.
    PROCEDURE
    • Place sternal paddle over right of the sternum
    below clavicle
    • Place apical paddle in mid axillary line in 5th IC
    space
    • Switch on the defibrillator
    • Charge the defibrillator to 200J or 360J
    • Warn all other rescuers to stand clear- ‘ARE YOU
    CLEAR’
    • Visually check all are clear
    • Ensure yourself you are not touching patient or
    bed ‘I AM CLEAR’
    • Deliver shock
    • Restart cpr with out checking pulse.
    Automatic External Defibrillator

    • Switch on AED.
    • Attach electrode pads.
    • Place electrodes as that of
    manual one
    • Follow voice commands
    • Make sure no one in contact
    with patient
    • Push shock button.
    1-Shock Protocol Versus 3-
    Shock Sequence
    • Evidence from 2 well-conducted pre/post design
    studies suggested significant survival benefit with
    the single shock defibrillation protocol compared
    with 3-stacked-shock protocols

    • If 1 shock fails to eliminate VF, the incremental


    benefit of another shock is low, and resumption of
    CPR is likely to confer a greater value than
    another shock
    Airway and Ventilations

    • Opening airway – Head tilt, chin lift or jaw thrust, in


    addition explore the airway for foreign bodies, dentures
    and remove them.
    Breathing devices

    BASIC AIRWAYS

    • Oropharyngeal airway
    • Nasopharyngeal airway

    • ADVANCED
    • Endotracheal tube
    • Laryngeal mask airway
    • Laryngeal tube
    • Esophageal tracheal tube
    Nasopharyngeal airway
    • commonly 6–7 mm in an adult female and 7–8 mm for an
    adult male
    OROPHARYNGEAL AIRWAY
    ENDOTRACHEAL TUBE
    Laryngeal mask airway
    Laryngeal tube
    90-115cm

    105-130

    122-155
    Esophageal tracheal tube
    Pharmacotherapy
    Routes of Administration
    Peripheral IV – must followed by 20 ml NS push
    Central IV – fast onset of action, but do not wait or
    waste time for CV line
    Intraosseous – alternative IV route in peds, also in
    Adult
    Intratracheally (down an ET tube)- not
    recommended now a days
    • Oxygen

    • IV Fluids
    Amiodarone (Cordarone)

    Indications:
    Vtach, Vfib

    • IV Dose:
    • 300 mg in 20-30 ml of N/S
    • Supplemental dose of 150 mg in 20-30 ml of N/S
    • Followed with continuous infusion of 1 mg/min for 6
    hours then .5mg/min to a maximum daily dose of
    2grams

    • Contraindications:
    Lidocaine
    • Indications:
    VT, VF
    Can be toxic so no longer given prophylactically

    • IV dose :
    1-1.5 mg/kg bolus then continuous infusion of 2-4
    mg/min
    Can be given down ET tube

    • Signs of toxicity:
    slurred speech, seizures, altered consciousness
    Magnesium

    Used for refractory VF or VT caused by hypomagnesemia


    and Torsades de Pointes

    Dose:
    1-2 grams over 2 minutes

    • Side Effects
    Hypotension
    Asystole
    • Propranolol/ Esmolol

    • Beta blocker that may be useful for VF and VT that


    has not responded to other therapies
    • Very useful for patients whose cardiac emergency
    was precipitated by hypertension
    Epinephrine

    • Alpha, beta-1, and beta-2 stimulation


    • Increases heart rate, stroke volume and blood pressure

    • IV Dose:
    1 mg every 3-5 minutes
    May increase ischemia because of increased O2
    demand by the heart
    Sodium Bicarbonate

    • METABOLIC acidosis / hyperkalemia

    • Airway and ventilation have to be functional

    • IV Dose:
    – 1 mEq/kg

    • Side effects:
    • Metabolic alkalosis
    • Increased CO2 production
    • Synchronised cardioversion - shock delivery that
    is timed (synchronized) with the QRS complex
    • Narrow regular : 50 – 100 J
    • Narrow irregular : Biphasic – 120 – 200 J and
    Monophasic – 200 J
    • Wide regular – 100 J
    • Wide irregular – defibrillation dose

    •
    ADENOSINE

    • Slows conduction time through the A-V node, can


    interrupt the reentry pathways through the A-V node
    • Pottasium channel opener and hyperpolarisation

    • IV Dose:
    6 mg rapid iv push, follow with NS flush..
    Second dose 12 mg

    Side effects:- Flushing of face, bronchospasm


    Cardiac Arrest Associated
    With Pregnancy
    causes
    B – Bleeding/ DIC
    E – Embolism( pulmonary, coronary , amniotic )
    A – Anesthetic complications
    U – Uterine atony

    C – Cardiac disease( MI/Aortic

    dissection/Cardiomyopathy)
    H – Hypertension ( Pre eclampsia/ Eclampsia )
    O – Other reversible causes
    Recommendation for emergency
    caesarean section

    Recommendation
    • When the gravid uterus is large enough to cause
    maternal hemodynamic changes due to
    aortocaval compression,
    • emergency caesarean section should be
    considered, regardless of fetal viability
    POST CARDIAC ARREST
    CARE
    Objectives
    • Optimize cardiopulmonary function and vital organ
    perfusion.

    • After out-of-hospital cardiac arrest, transport


    patient to an appropriate hospital with a
    comprehensive post–cardiac arrest treatment

    • Transport the in-hospital post– cardiac arrest


    patient to an appropriate critical-care unit

    • Try to identify and treat the precipitating causes of


    the arrest and prevent recurrent arrest
    Action in time can save a
    life!!!
    THANK YOU

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