ADVANCED CARDIAC
LIFE SUPPORT (ACLS)
ACLS ALGORITHMS
Conscious INITIAL IMPRESSION Unconscious
(appearance) Consciousness (appearance)
Breathing
Color
PRIMARY ASSESSMENT BLS ASSESSMENT
Airway
Breathing
Circulation
Disability (LOC, Pupil Dilation, AVPU)
Exposure (Bleeding, Burns, Trauma, Medical Alert Bracelet)
SECONDARY ASSESSMENT
Signs and Symptoms HYPOVOLEMIA TENSION PNEUMOTHORAX
Allergies HYPOXIA TAMPONADE, CARDIAC
Medications HYDROGEN ION ACIDOSIS TOXINS
Past Medical History HYPERKALEMIA THROMBOSIS PULMONARY
Last Meal HYPOKALEMIA THROMBOSIS CORONARY
Events HYPOTHERMIA
V VISUALIZE
VITAL SIGNS
VERBALIZE
O OXYGENATE
M MONITOR
I IV/IO
T TREAT
CONSCIOUSNESS
VISUALIZE BREATHING
COLOR
AIRWAY
VITAL SIGNS BREATHING (Respiratory Rate, Work of Breathing, SpO2, Breath Sounds)
CIRCULATION (Heart Rate, Blood Pressure, Central and Peripheral Pulses, CRT)
DISABILITY (AVPU)
EXPOSURE (Temperature, Bleeding, Burns, Trauma, Medical Alert Bracelet)
SIGNS AND SYMPTOMS
VERBALIZE ALLERGIES
MEDICATIONS
PAST MEDICAL HISTORY
LAST MEAL
EVENTS
OXYGENATE Provide Supplemental Oxygenation
If the oxygen saturation is less than 90%
NASAL CANNULA 2-4 LPM
SIMPLE FACE MASK 6-10 LPM
NON-REBREATHER MASK 11-15 LPM
MONITOR Hook the patient to the Cardiac Monitor
Monophasic White, Black, Red
(White to Right, Smoke over Fire)
Biphasic Red, Yellow, Green
(Traffic Light)
IV/IO Establish a vascular access
Intravenous Antecubital Veins
Humeral Head, Sternum, Proximal
Intraosseouss
Tibia, Distal Malleolus
DOSE : 1 mg
A ATROPINE SULFATE MAX: 3 mg
TOTAL: 3 doses
Time interval: Every 3 to 5 minutes
• PUT PACER PADS
T TRANSCUTANEOUS PACING
(TCP)
•
•
•
•
SET RATE
SET mAMP
PACE (achieve COMPLETE Capture)
CONFIRM PULSE
D DOPAMINE INFUSION 5 -20 MCGS/KG/MIN
E
TITRATE to patient response
EPINEPHRINE INFUSION INITIAL: 2 mcg per minute
MAX: 10 mcg per minute
VAGAL MANEUVER
S
T
A
P PHYSIOLOGIC CAROTID MASSAGE
COUGH/STRAIN
B ADENOSINE: (RAPID IV
L
E
P PHARMACOLOGIC BOLUS)
INITIAL DOSE: 6 mg
2ND DOSE: 12 mg
U Diazepam
N
S
T
S SEDATE
Midazolam
Etomidate
Propofol
A
ENERGY DOSE
B
L
E
S SYNCHRONIZED
CARDIOVERSION
• Atrial Fibrillation – 120-200 J
• SVT – 50 J initial
S Seek EXPERT CONSULTATION
T REGULAR MONOMORPHIC V TACH
A Adenosine: (Rapid Iv Bolus)
INITIAL DOSE: 6 mg
B
L
E
P PHARMACOLOGIC 2ND DOSE: 12 mg
Amiodarone infusion
Dose: 150 mg
Duration: 10 minutes
U Diazepam
N
S
T
S SEDATE
Midazolam
Etomidate
Propofol
A
B
L
E
S SYNCHRONIZED
CARDIOVERSION
ENERGY DOSE
• V Tach – 100 J initial
RESPONSIVENESS No response?
ASK FOR HELP Help! Someone Help!
CAROTID PULSE 5-10seconds
AND BREATHING No pulse?
Activate Emergency Response
CALL ERS
And Get an AED/Defib
PUSH HARD At least 2 inches or 5 cm
PUSH FAST 100 - 120 per minute
ALLOW COMPLETE CHEST Do not Lean
RECOIL
MINIMIZE INTERRUPTIONS Limit to <10 sec
AVOID EXCESSIVE 2 breaths after every
VENTILATION 30 compressions
START High Quality CPR
RHYTHM
ASYSTOLE / PEA
VF/ PULSELESS VT (SHOCKABLE)
(NON-SHOCKABLE)
C1 HQCPR C1 HQCPR
C2A SHOCK 360 J EPINEPHRINE 1 mg (1:10,000) +20cc
C2B
NO DRUG NSS every 3-5 minutes
2MIN SAS
C1 HQCPR
TREAT: REVERSIBLE CAUSES OF CARDIAC ARREST
C2A SHOCK 360 J
EPINEPHRINE 1mg (1:10,000) +20cc H’s T’s
C2B
NSS
• HYDROGEN ION ACIDOSIS • TAMPONADE. CARDIAC
2MIN SAS • HYPOXIA • TENSION PNEUMOTHORAX
C1 HQCPR • HYPO/HYPERKALEMIA • THROMBOSIS, CORONARY
C2A SHOCK 360 J • HYPOTHERMIA • THROMBOSIS, PULMONARY
C2B AMIODARONE 300mg + 20cc NSS
• HYPOVOLEMIA • TOXINS
ADVANCED AIRWAY:
AB No spontaneous
breathing
Primary confirmation- 5-pt auscultation
Secondary confirmation:
Qualitative - yellow
Quantitative – 35 to 45 mmHg PETCO2
C Unstable BP
• 1-2L PNSS/PLRS
• Dopamine 2-10 mcg/kg/min
• Epinephrine 2-10mcg/min
TARGETED TEMPERATURE MANAGEMENT
D Comatose • 30 mL/kg PNSS/PLRS 4oC x 30mins
• Core body temp: 32-36
• At least 24 hours
NGT
CVP 12-LEAD
POST ARREST CARE CXRAY
URINARY CATHETER
A
VISUALIZE 1. HARD RESCUE BREATHING: 1 q 5-6 sec
CONSCIOUSNESS, BREATHING, COLOR 2. FAST ADVANCED AIRWAY:
V VITAL SIGNS & ABCDE
HR, BP, RR, SpO2, Temp
AIRWAY, BREATHING, CIRCULATION
DISABILITY, EXPOSURE
VERBALIZE
30:2 3.
4.
5.
Complete Chest Recoil
Interruption <10 sec
Avoid Excessive Ventilation
PETCO > 10 mmHg
SHOCKABLE (VF/ PULSELESS VT) B
Primary confirmation:
5-pt auscultation
Secondary confirmation:
Qualitative - Yellow
Quantitative - Waveform Capnography
SAMPLE SAS (STOP, ANALYZE, SWITCH)
O C
2 mins Class 1- HQCPR
OXYGENATE if SpO2 < 90% Class 2a- SHOCK 360 J
1-2L PNSS/PLRS
Nasal Cannula 2-4 Dopamine 2-10 mcg/kg/min
Face Mask 6-10 SAS
NRM 11-15 Class 1- HQCPR Epinephrine 2-10mcg/min
2 mins Class 2a- SHOCK 360 J
M D
Class 2b- Epinephrine TARGETED TEMPERATURE MANAGEMENT
Pads on Chest SAS 30 mL/kg PNSS/PLRS 4oC x 30mins
Electrodes on Chest Class 1- HQCPR Core body temp: 32-36
2 mins Class 2a- SHOCK 360 J
At least 24 hours
I
Class 2b- Amiodarone 300
Establish an IV/IO Access SAS NGT
SLOW Class 1- HQCPR
2 mins CVP 12-LEAD
A – ATROPINE Class 2a- SHOCK 360 J
T T – TCP
D – DOPAMINE INFUSION
E – EPI INFUSION
FAST
2 mins
Class 2b- Epinephrine
SAS
Class 1- HQCPR
Class 2a- SHOCK 360 J
Class 2b- Amiodarone 150
CXRAY
URINARY CATHETER
NARROW WIDE
P – VAGAL MANUEVER P – ADENOSINE NON-SHOCKABLE (ASYSTOLE/ PEA)
P – ADENOSINE P – AMIO INFUSION Class 1- HQCPR
S – SEDATE S – SEDATE Class 2- Epinephrine q 3-5 minutes
S – SYNCHRONIZE S – SYNCHRONIZE STEMI – CATH LAB
CARDIOVERSION CARDIOVERSION Treat Reversible Causes H’s & T’s
NSTEMI - ICU