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ACLS Training: Organized By: Department of Anesthesiology and Intensive Care, DMCRI

This document provides information about Advanced Cardiac Life Support (ACLS) training organized by the Department of Anesthesiology and Intensive Care at DMCRI in Butwal. It discusses the objectives of integrating basic life support into ACLS, recognizing arrest rhythms, using defibrillation and drugs during cardiac arrest, and post-cardiac arrest care. The key steps outlined are high quality chest compressions, airway management, monitoring with end-tidal CO2, administering drugs like epinephrine as needed, and treating potentially reversible causes of arrest.

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Resham Rana
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60 views50 pages

ACLS Training: Organized By: Department of Anesthesiology and Intensive Care, DMCRI

This document provides information about Advanced Cardiac Life Support (ACLS) training organized by the Department of Anesthesiology and Intensive Care at DMCRI in Butwal. It discusses the objectives of integrating basic life support into ACLS, recognizing arrest rhythms, using defibrillation and drugs during cardiac arrest, and post-cardiac arrest care. The key steps outlined are high quality chest compressions, airway management, monitoring with end-tidal CO2, administering drugs like epinephrine as needed, and treating potentially reversible causes of arrest.

Uploaded by

Resham Rana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ACLS Training 2016

Organized by:
Department of Anesthesiology and
Intensive Care, DMCRI
1
CPR: ACLS
CPR Team
Anesthesiology & Intensive Care
DMCRI, Butwal
CPR: ACLS
 Sequence of procedures performed to
restore the circulation of oxygenated
blood after a sudden pulmonary and/or
cardiac arrest is CPR.

 Chest compressions and pulmonary


ventilation performed by anyone who
knows how to do it, immediately, with
drugs and equipment is ACLS.
Objectives:
 Integration of BLS into ACLS
– Chest compressions,
– Airway & breathing,
 Recognition of arrest rhythm
 Use of Defibrillation & Drugs,
 What else? During CPR
 Immediate post-cardiac arrest Rx
Initial steps:
Assess “A-B-C” to Perform “C-A-B”

A–B–C
C–A–B
Airway & breathing
 Airway& breathing to be assessed
in unresponsive patients,

 Start
high quality chest
compression in absence of
breathing after activating EMS
Chest compressions

Chest compressions and


early defibrillation.

C–A–B
High quality Chest compression:
High quality Chest compression:

 Push hard 5 cm depth


 Push fast at 100 – 120 per minute
 Allow full chest recoil
 Change rescuer every 2 minutes
 Minimize interruptions in compressions
Airway & breathing

 Airway to be managed by
supraglottic device in absence of
expert intubator,
Airway & breathing
 Optimal respiration rate and tidal
volume:
– 10 breaths/min
– BVM ventilation: with 100% oxygen,
– Chest to be visibly rise (TV 6-7 ml/kg)
– Ventilation during decompression of
chest
Capnography
 to confirm & continually
monitor tracheal tube
placement,
 to monitor quality of CPR and
 to provide an early indication
of ROSC
Capnography: ETT confirmation

Capnography to confirm endotracheal tube placement.

Capnography Waveform
Capnography for quality CPR
Capnography for ROSC

Capnography to monitor effectiveness of resuscitation efforts.

Capnography Waveform
Ventilation strategy:
 Chest compression to ventilation ratio:
– 30:2 (1 or 2 rescuer) until advanced airway
management,
– Airway device: 10 breaths / minute
 Capnography:
– PETCO2 : <10 mmHg, attempt to improve
CPR quality
During CPR: what else?
 Ensure high quality CPR
 Give oxygen
 Plan actions without interrupting CPR
– Adv airway, Capnography, defibrillation & drugs

 ECC when advanced airway in place


 Vascular access: warm fluids 1 liter bolus
 Defibrillation & / or drugs as protocol
 Treat reversible causes
Rhythm assessment:
Shockable rhythms:
Ventricular fibrillation
Pulseless VTs (pVT)
Pulseless VTs (PVT)
Algorithm:
Steps: Shockable rhythms
1. Once Defibrillator is available:
deliver shock as soon as possible
2. Start chest compression for 2
minutes without rhythm analysis,
3. 2 further shocks if persistent
shockable rhythm with chest
compression,
4. After third shock: shock followed by
chest compression & drugs,
Steps: Shockable rhythms
Shock 1 – followed by ECC 2 mins

Shock 2 – followed by ECC 2 mins

Shock 3 – followed by ECC & drugs


Shock energy:
 Monophasic:
– 360 J one to all.
 Biphasic:
– As per manufacturer recommendation
– Second and subsequent doses should be
equivalent or higher
150J– 200J – 250J,
What else?

 IV access and blood investigations


 Warm fluid iv bolus
 Advanced airway management
 Ventilation with high flow oxygen
Steps: Shockable rhythms

Adrenaline Adrenaline Adrenaline


Amiodarone Amiodarone
300 mg iv 150 mg iv
Drug/s:
 Give Adrenaline 1 mg after third
shock then every 4 minutes,
 Amiodarone 300 mg can be delivered
simultaneously along with the
adrenaline,
 Further single dose of amiodarone
150 mg iv after 4 minutes is delivered
in resistant / refractory cases
Drugs:
 Use lidocaine in absence of
amiodarone
 1-1.5 mg/kg bolus
 Continue high quality CPR
What else? Reversible causes:

‘H’s ‘T’s
 Hypoxia,  Txn Pneumothorax,
 Hypovolemia,  Tamponade – cardiac,
 Hypo/hyperkalemia,  Toxins / drugs,
 Hypothermia,  Thrombosis
Immediate Post-cardiac arrest Rx
 ABCDE approach
 Aim SaO2 94 – 98%
 Aim Normal PaCO2
 12-lead ECG
 Address precipitating cause
 Targeted temperature management
Queries / Comments
Summary
 High quality ECC
 Airway & breathing: LMA or ETT
with O2
 Monitor with ETCO2
 Drugs: Adrenaline, amiodarone etc.
as needed
 Look & address the causes:
– 4 Hs & 4 Ts
Thanks!!
Steps: Non shockable rhythms

Adrenaline Adrenaline Adrenaline


Immediate Post-cardiac arrest Rx
 ABCDE approach
 Aim SaO2 94 – 98%
 Aim Normal PaCO2
 12-lead ECG
 Address precipitating cause
 Targeted temperature management
Summary
 Transformation to ACLS
– Chest compressions,
– Airway & breathing,
 Recognition of arrest rhythm
 Use of Defibrillation & Drugs,
 What else? During CPR
 Immediate post-cardiac arrest Rx
Cardiac Arrest.flv
Non shockable rhythms:
Asystole
Asystole
PEA / EMD:
Algorithm:
Drugs:
 High quality CPR
 Assess every 2 minutes
 Adrenaline 1 mg every 4
minutes,
 Find the reversible causes of
arrest in the line of ‘H’s and ‘T’s
and manage accordingly
NON SHOCKABLE RHYTHM
Assess Assess Assess Assess Assess

Adrenaline Adrenaline Adrenaline


1 mg iv 1 mg iv 1 mg iv
What else? Reversible causes:

‘H’s ‘T’s
 Hypoxia,  Txn Pneumothorax,
 Hypovolemia,  Tamponade – cardiac,
 Hypothermia  Thrombosis
 Hypo/hyperkalemia,  Toxins / drugs,

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