Introduction

Introduction – All ACLS providers treating patients must ensure that they maintain the minimal level of competency, which includes knowledge— some of which is provided here— as well as important physical skills. This study guide assumes learners have the skills of Basic Life Support (BLS) specific to adult populations. This course will provide a brief overview of basic CPR in adults, however, if a learner is not proficient in these skills, he or she should gain proficiency by taking the necessary coursework or obtaining the physical skills needed.

The Initial Evaluation

The Initial Evaluation – Always ensure that the area is safe before attempting to care for a patient with an emergency. The initial assessment should evaluate for consciousness.

Basic Life Support

Changes to the BLS Guidelines: 2015 – The AHA updated its guidelines for BLS in 2015. The Emergency Cardiovascular Care (or ECC) recommendations provided more evidence supporting the previous updates from 2010. The AHA has a full review of the changes in its executive summary report.

BLS in Adults – The AHA revised the clinical guidelines of BLS in 2010. These guidelines include information regarding emergency cardiovascular care (ECC) and cardiopulmonary resuscitation (CPR).

Implementing the Survival Chain – Basic Life Support delivers life-saving management of the patient with an emergent condition and is therefore continuously updated by the AHA to provide the most current and beneficial treatments to patients.

One Provider BLS in Adults – Stay safe, Assess, Call 911, CPR, Defibrillate, CPR Steps.

Two Provider BLS in Adults – If there are two or more providers, BLS is performed differently. During BLS, ask your partner to call EMS. Your partner can use a mobile device with a hands free option or speakerphone to contact 911 at the patient’s side.

Mouth-Mask and Bag-Mask Respirations – In you are the only provider, provide rescue breaths with a face mask, if you have one.

BLS Algorithm in Adults – Infographic.

Advanced Cardiac Life Support

Basic Anatomy and Physiology of the Heart – ACLS requires a basic understanding of the anatomy and physiology of the heart. The heart sits within the chest and consists of four hollow compartments which are divided by a thick muscular wall or septum.

ACLS Survey (The ABCD Pathway) – Airway, Breathing, Circulation, Disability.

Airway Management – When rescue breaths with the bag mask are sufficient, there is no need for a adjuncts to airway management.

Basic Adjuncts to the Airway – OPAs can only be used in the unconscious patient without an intact gag or cough reflex. NPAs can be used in the conscious patient with an intact gag reflex. Do not use the NPA in a patient with a facial fracture as this can worsen the injury and it can accidently be removed. Never exceed more than 10 seconds while suctioning as the patient is without oxygen at this time. Provide oxygen after completing suction maneuvers.

Techniques for Basic Airway Adjuncts – OPAs must be correctly sized to avoid obstruction of the airway. Incorrectly sized NPAs can extend into the esophagus leading to inefficient ventilation. Ensure that the patient spontaneously respires following insertion of either the OPA or NPA.

Advanced Adjuncts to the Airway – Provide 30 compressions for every 2 breaths. Provide continuous compressions when an advanced airway is in place. Provide each breath in 6 -8 second intervals. Never over ventilate the patient by providing to rapid or too large breaths as this can worsen hemodynamic parameters by increasing the intrathoracic pressure (lowered cardiac preload and therefore lowered cardiac output). It also puts the patient at risk for gastric distention which can lead to aspiration pneumonia.

Access for Medications Administration – CPR is vital in allowing medications to take their effect. The medication may take as much as 2 minutes to reach the central vasculature and even longer to produce its effect. Therefore CPR should be used to aid in delivery. All medications and fluids can be administered both intravenously and intraosseously.

Medications – All the ACLS medications (see Table 1) should only be used once the provider is fully aware of the mechanism of action as well as the possible side effects— and how to manage these.

Principles Of Defibrillation Use

Principles of Defibrillation Use – CPR and defibrillation work together, when used early in the care of cardiac arrest victim to increase survival.

AED Use in Adults – Do not waste time trying to fix the AED if it is not properly working. CPR is vital and should not be stopped for longer than 10 seconds or the child becomes responsive. The AED cannot be used in water. Remove all medication patches ad clean off any medication before applying the pads. Do not place pads over a skin bulge as this may indicate a pacemaker.

ACLS Care Systems

ACLS Care Systems – Care systems coordinate different groups of professionals include the RRT, Cod team and critical care teams to deliver excellent care to the cardiac arrest patient. The AHA 2015 guidelines indicates that RRTs provide improved outcomes for cardiac arrest patients.

Cardiopulmonary Resuscitation – Successful CPR is founded on the Survival chain, a link of diverse groups that work together to provide excellent care for the cardiac arrest patients.

Providing After-Cardiac Arrest Care – It is vital that after each resuscitation, team members come together to review the results of the resuscitation as well as provide both positive and negative feedback.

Acute Coronary Syndrome (or ACS) – ACS is a common cause for cardiac emergencies and early diagnosis is essential for treatment.

Stroke – Diagnosis and management of stroke can be remembered easily via the eight D’s of Stroke Treatment (Table 3). It also highlights key areas to minimize delays.

The Resuscitating Team – Team members and leaders must communicate effectively.

Educating and Implementing Effective Teams – Hospitals with RRTs or METs improve patient care, cardiac arrests are reduced, fewer patients are transferred to the ICU, survival improves and patients are discharged earlier.

ACLS Cases

Recognizing Respiratory Distress and Failure – Respiratory arrest occurs when the patient is not breathing or ineffectively breathing and is an emergency.

Ventricular Fibrillation (V fib) and Pulseless Ventricular Tachycardia (V tach) – V fib and pulseless V tach are both treated by shock. However the AED is unable to asses for a pulse.

Pulseless Electrical Activity (PEA) and Asystole – Neither PEA nor asystole are treated by shock. Ensure that there is no mechanical error causing asystole. Ensure the cardiac leads are not incorrectly connected, there is no inappropriate gain or lack of power. Hypoxia and hypovolemic shock are reversible and commonly cause PEA.

Adult Algorithm for Cardiac Arrest – Characteristics of Good Quality CPR, Energy of Shock, Return of Spontaneous Circulation (ROSC), Advanced Airways, Medication Therapy, Reversible Causes (H’s and T’s).

Providing After Resuscitation Care – Following the return of spontaneous circulation (ROSC), begin after resuscitation care at once.

Algorithm for After Cardiac Arrest Care in Adults – Infographic.

Symptomatic Bradycardia – ECG for Sinus Bradycardia, ECG For First Degree AV Block, ECG for 2nd Degree AV Block (Type I or Wenkebach), ECG For 2nd AV Block (Type II or Mobitz II), ECG For 3RD Degree (Complete) AV Block, Symptomatic Bradycardia, Signs and Symptoms of Bradycardia.

Algorithm for Bradycardia with Pulse in Adults – Infographic.

Tachycardia – Consult cardiology if there is any concern with treating stable tachycardia patients as inappropriate treatment can render them unstable. Adverse event of adenosine is spasm of the bronchial tree, so use with extreme caution in patients with reactive airway disease.

Symptomatic Tachycardias – ECG for Sinus Tachycardias, ECG for Atrial Flutter, ECG for Irregular Narrow QRS Complex Or Atrial Fibrillation (A Fib).

Algorithm for Tachycardia with Pulse in Adults – Infographic.

Acute Coronary Syndrome (or ACS) – ACS refers to a number of acute cardiac conditions that may be immediately life threatening.

Algorithm for ACS in Adults – Infographic.

Stroke – Ensure the patient can swallow before administering medication by mouth. All patients must be have swallow study done to ensure safety or oral intake. The suspected stroke patient must be evaluated by the expert team within 10 minutes of arrival at the hospital door. Perform and complete Head CT scan by 45 minutes after arrival at the hospital door.

Algorithm for Acute Stroke in Adults – Infographic.

ACLS Skills Training

ACLS Skills Video – Video

Airway Management Video – Video

ACLS Certification Exam – The ACLS Certification Exam requires a passing score of 80%.