Advanced Life Support
Advance Life Support includes use of adjunctive equipments and
techniques for :-
I. Assisting ventillation and circulation
II. ECG monitoring with dysrhythmia recognition and defibrillation
III. Establishment of I.V access and pharmacologic therapy in addition
to BLS skills.
ALS
algorithm
I. Assisting Ventillation and Circulation includes :
• Circulation (by cardiac compression)
• Airway management by equipments
• Breathing by advanced technique
Circulation [C]
Chest Compression:
Rate - 100/min
Place – mid sternum
Depth – at least 5cm ( 2inches) or 1/3 of AP diameter of chest
No synchrony with respiration
Airway management [A]
1. Guedels Airways – Most commonly used
2. Laryngeal Mask Airways
3. Endotracheal Tube
Breathing [B]
Breathing can be accomplished by :
1. Bag and mask ventilation
2. Ventilation by advanced method:
ET tube : Intubation is most definitive and best method for
ventilation.
LMA
Tracheostomy tube
3. Ventilation by automatic ventilators.
Bag and Mask Ventillation
AMBU bag
Artificial Manual Breathing Unit (AMBU)
It consist of self inflating bage made up of rubber or silicon, a
connector, safety valve, mouth piece.
100% pure oxygen can be delivered by AMBU bag by attaching oxygen
source and oxygen reservoir.
II. ECG monitoring with dysrhythmia recognition and defibrillation
Ventricular Tachycardia
Ventricular Fibrillation
Defibrillation
• These are the treatment for tachydysrhytmias.
• Defibrillation depolarizes the critical mass of myocardial cell at once.
When they repolarize the sinus node recapture its role as the
pacemaker.
• Is treatment of choice for pulseless VT/VF
Defibrillator
Defirillators can be classified as
• Monophasic (delivers current of one polarity)
• Biphasic (deliver current of 2 polarity)
Position of defibrillator paddle
1st paddle (on the right side of the chest just below the clavicle)
2nd paddle(at precordial region)
* Paddles should be applied with pressure equivalent to 10kg.
Paddle size
• Adult : 13cm
• Children : 8cm
• Infants : 4.5cm
[Latest Recommendation for shock protocol]
Previous recommendation of 3 successive shock (200 J,300 J,360 J)
Nowadays only a single shock is recommended:
360 J by monophasic
150- 200 J by biphasic
III. Establishment of I.V access and pharmacologic therapy in
addition to BLS skills.
DRUGS
1. Adrenaline (all types of cardiac arrest) 1mg every 3-5 mins
2. Amiodarone (VF,VT) 1st dose : 300mg IV bolus , 2nd dose : 150mg
3. Lidocaine (if amiodarone isn’t available)
4. Sodium bicarbonate (only if cardiac arrest is associated with
hyperkalemia or tricyclic anti-depressant overdose)
5. Calcium gluconate
Adrenaline (epinephrine)
Class : Adrenergic
MOA : causes cardia stimulation
Indication : cardiac arrest
Dose : Adult 0.5 – 1 mg IV (repeat every 5min)
Children 10mcg/kg
Adverse reaction : nervousness , tremor , headache , drowsiness ,
palpitation , tachycardia , dyspnea.
Amiodarone
Class : ventricular antiarrhythmic
MOA : abolishes ventricular arrhythmia
Indication : recurrent VF , unstable VT , atrial fibrillation
Dose : 300mg IV ; further 150mg may be given
followed by an infusion of 900mg for 24 hour.