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A (ACLS) - 2015: Dvanced Cardiac Life Support

Advance cardiac life support is an emergency response or emergency care given to a victim who have suddenly heart attack.

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Najmussaqib
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72 views

A (ACLS) - 2015: Dvanced Cardiac Life Support

Advance cardiac life support is an emergency response or emergency care given to a victim who have suddenly heart attack.

Uploaded by

Najmussaqib
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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ADVANCED CARDIAC LIFE

SUPPORT(ACLS) – 2015
PRESENTER.
MR .IMTIAZ HUSSAIN BANGASH
ADVANCED CARDIAC LIFE SUPPORT
 Advanced cardiac life support or advanced
cardiovascular life support (ACLS) refers to a set
of clinical interventions for the urgent treatment of
cardiac arrest, stroke and other life-threatening
medical emergencies, as well as the knowledge
and skills to deploy those interventions.
IMPORTANCE OF BLS IN ACLS

 ACLS is built heavily upon the foundation of BLS


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)
(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 automated external defibrillator
before beginning CPR
Otherwise, send someone and begin CPR
immediately; use the AED as soon as it is available
In case of unwitnessed collapse of children or infant
give CPR for 2 mins before leaving the victim
and getting the AED then resume CPR
Chest compression-
Adult- 30:2
Children or infant-
30:2 if one rescuer
1
5
:
2
if
m
o
r
e
 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.
A CHANGE FROM A-B-C TO C-A-B
BLS DON’TS OF ADULT HIGH-QUALITY CPR

1.compression rate slower than 100/ min or faster


than 120/min
2.Compression depth less than 5 cm or greater
than 6 cm
3. Lean on the chest between compression
4. Interrupt compressions for greater than 10
secs
5. Provide excessive ventilation- ie, too many
breaths or breaths with excessive force
ADULT ADVANCED CARDIOVASCULAR LIFE
SUPPORT
RECONGNITION OF ARRYTHMIA

Lethal or non lethal

Symptomatic or asymptomatic

Stable or unstable

Shockable or unshockable
Shockable

VT VF
Monomorphic or Fine or Coarse
polymorphic VF
Unshockable

PEA- pulseless
electrical activity or
Asystole EMD-
electromechanical
dissociation
MEANWHILE…
 Minimize interruption in CPR- alternate CPR
provider every 2 minutes as continued Chest
compression may fatigue the provider leading to
ineffective compression
 Maintain an orchestra of activity between physician,
nurse and other health care provider (Ward boy)
 Check airway patency- consider oropharyngeal
tube placement if tongue fell back.
 Arrange for endotracheal tube/ maximize oxygen
delivery
Deliver single defibrillitor
shock CPR-2 mins
Check rhythm

VT/ VF

Deliver single shock- if VT


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

Amiodarone/ Lidocaine/ Magnesium sulfate

Defibrillate: Drug---Shock---Drug----
Shock
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

 If cardiac arrest still persist- patient is intubated and


IV/IO access achieved
 Defibrillation Sequence
●Turn the AED on.
● Follow the AED prompts.
●Resume chest compressions immediately after
the shock(minimize interruptions).
ASYSTOLE/PEA

Continue CPR (Intubate Identify and Continue


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
AIRWAY AND VENTILATIONS
 Opening airway – Head tilt, chin lift or jaw thrust, in
addition explore the airway for foreign bodies, dentures and
remove them. Consider oropharyngeal tube placement.

 The Health care provider should open the airway and give
rescue breaths with chest compressions
RESCUE BREATHS
 By mouth-to-mouth or bag-mask
 Deliver each rescue breath over 1 second

 Give a sufficient tidal volume to produce


visible chest rise
 Use a compression to ventilation ratio of 30
chest
compressions to 2 ventilations
 After advanced airway is placed, rescue
breaths given asynchronus with ventilation
 1 breath every 6 to 8 seconds (about 8 to 10
breaths per minute)
BREATHING DEVICES
 Plastic oropharyngeal airways
 Esophageal obturators

 Ambu bag- usual method for continuing breathing in


hospital before ET tube can be inserted.
 Endotracheal tube
PHARMACOTHERAPY
ROUTES OF ADMINISTRATION
Peripheral IV – easiest to insert during CPR, 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
• FIO2 100%
• Assist Ventilation
• O2 Toxicity should not be a concern during ACLS

IV Fluids
Volume Expanders
• crystalloids , e.g. Ringer’s lactate, N/S
 Amiodarone (Cordarone)
• Indications:
– Like Lidocaine – Vtach, Vfib
• IV Dose:
– 300 mg in 20-30 ml of N/S or D5W
– Supplemental dose of 150 mg in 20-30 ml of N/S or
D5W
– Followed with continuous infusion of 1 mg/min for 6
hours than .5mg/min to a maximum daily dose of 2
grams
• Contraindications:
– Cardiogenic shock, profound Sinus Bradycardia, and
2nd and 3rd degree blocks that do not have a
pacemake
 Lidocaine
• Indications:
– PVCs, Vtach, Vfib
– 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 Vfib or Vtach 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 Vfib and Vtach
that has not responded to other
therapies
– Very useful for patients whose cardiac emergency
was precipitated by hypertension
– Also used for Afib, Aflutter, & PSVT
 Epinephrine
• Because of alpha, beta-1, and beta-2
stimulation, it increases heart rate, stroke
volume and blood
pressure
– Helps convert fine vfib to coarse Vfib
– May help in asystole
– Also PEA and symptomatic bradycardia
• IV Dose:
– 1 mg every 3-5 minutes
– May increase ischemia because of
increased
O2 demand by the heart
 Vasopressin (ADH)- is out according to 2015
guidelines for ACLS
 Sodium Bicarbonate
• Used for METABOLIC acidosis / hyperkalemia

– Airway and ventilation have to be functional


• IV Dose:
– 1 mEq/kg
– If ABGs, [BE] x wt in kg/6
• Side effects:
– Metabolic alkalosis
– Increased CO2 production
MONITORING DURING CPR
Physiologic parameters
 Monitoring of PETCO2 (35 to 40 mmHg)
 Coronary perfusion pressure (CPP) (15mmHg)
 Central venous oxygen saturation (ScvO2)

 Abrupt increase in any of these parameters is a


sensitive indicator of ROSC that can be monitored
without interrupting chest compressions
Quantitative waveform capnography
 If Petco2 <10 mm Hg, attempt to improve CPR
quality
Intra-arterial pressure
 If diastolic pressure <20 mm Hg, attempt to
improve
CPR quality
 If ScvO2 is < 30%, consider trying to improve the
quality of CPR
INITIAL OBJECTIVES OF POST– CARDIAC
ARREST CARE

 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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