The ACLS certification course teaches healthcare professionals advanced interventional protocols and algorithms for the treatment of cardiopulmonary emergencies. These include primary survey, secondary survey, advanced airways, myocardial infarction, cardiac arrest, tachycardias, bradycardias, and stroke. The treatment protocols have been established through collaborative clinical research and later published by the International Liaison Committee on Resuscitation ILCOR. If the patient is not ventilating well or if there is a presumed risk of aspiration, insert an advanced airway device when prudent: Endotreacheal Intubation is the preferred method.
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The ACLS certification course teaches healthcare professionals advanced interventional protocols and algorithms for the treatment of cardiopulmonary emergencies.
These include primary survey, secondary survey, advanced airways, myocardial infarction, cardiac arrest, tachycardias, bradycardias, and stroke. The treatment protocols have been established through collaborative clinical research and later published by the International Liaison Committee on Resuscitation ILCOR. If the patient is not ventilating well or if there is a presumed risk of aspiration, insert an advanced airway device when prudent: Endotreacheal Intubation is the preferred method.
View the advanced airway section. There are two important principles when evaluating the airway and breathing. First, is the airway patent or obstructed. Second, is there possible injury or trauma that would change the providers method of treating an obstructed airway or inefficient breathing. The provider may also be able to hear or feel the movement of air from the patient. A completely obstructed airway will be silent. An awake patient will lose their ability to speak, while both a conscious or unconscious patient will not have breath sounds on evaluation.
The provider will also not feel or hear the movement of air. If the airway is partially obstructed snoring or stridor may be heard. Cervical Spine Injury? If the provider evaluates the patient to have an obstructed airway, intervention should take place. If the adverse event of the patient was witnessed and there is no reason to suspect a cercival spine injury, the provider should use the head tilt-chin lift maneuver to open the airway.
If neither technique works, attempt an advanced airway using inline stabilization. Brain Injury? The breathing center that controls respirations is found within the pons and medulla of the brain stem. If trauma, hypoxia, stroke, or any other form of injury affects this area, changes in respiratory function may occur.
Some possible changes are apnea cessation of breathing , irregular breathing patterns, or poor inspiratory volumes. If the breathing pattern or inspiratory volumes are inadequate to sustain life, rescue breathing will be required, and an advanced airway should be placed.
Remember, a patient should be unconscious or sedated without an active gag reflex before instrumentation of the airway occurs with an ETT, Combitube, or LMA.
First attempt confirmation of esophageal intubation by ventilating through the esophageal tube. Positive pressure ventilation is generally kept under 20 CmH2O to prevent inflation of the stomach. The patient is still at high risk of aspiration, even with an appropriately placed LMA.
Transcutaneous Pacemaker External Pacemaker : Used to treat unstable bradycardias not responding to drug therapy. Provides temporary pacing through the skin in emergency situations. Shock energy level: Monophasic: J Biphasic: factory recommendations generally J Assure the patient is sedated and comfortable during shock delivery. Shock energy level: Monophasic: J Biphasic: factory recommendations generally J. Ventricular Tachycardia monomorphic :. Atrial Fibrillation with Aberrancy:.
Atrial Fibrillation with Wolff Parkinson White delta wave :. Ventricular Tachycardia VT — monomorphic:. Ventricular Tachycardia VT — polymorphic:. You and a few others hurry to her side and she quickly becomes unresponsive. You run to the bay to find a patient confused, obtunded, and lethargic in the bed. The nurse is unable to cycle a blood pressure. When assessing the ECG you see:. Choking Intervention for Infants. Airway and Breathing. Advanced Airways. Cardiac Rhythms. Acute Myocardial Infarction.
Acute Stroke. Airway two provider. Initially provide rescue breaths using an ambu bag and a mask at full flow oxygen. Perform continued assessment of airway patency while giving breaths. Have the person doing chest compressions pause during the 2 rescue breaths. Confirm correct placement of the advanced airway device:.
Look for condensation during exhalation. Look for equal bilateral chest rise. Confirming equal bilateral breath sounds with auscultation.
If incorrect placement:. Remove the airway device, ventilate the patient using the ambu bag for a short period of time, and then reattempt placement. If correct placement:.
Secure placement of the airway device. Continue to monitor:. Rescue breathing during CPR with an advanced airway:. Obtain IV or IO access. Initiate therapy of ACLS algorithm corresponding with the identified heart rhythm.
Drug therapy, Electrical therapy, Pacing, etc. Differential Diagnosis. Differential Diagnosis Chart:. Oral Airway:. Assure the artificial airway is the appropriate size for the patient. The airway should be easily inserted with a tongue blade. Avoid use in patients with an active gag reflex. Nasal Trumpet Airway:. Best practice is to lube before insertion. Careful not to cause trauma to nasal mucosa results in bleeding.
This is reasonably tolerated by patients with an active gag reflex. When you are unable to open airway using head tilt-chin lift or jaw thrust maneuvers. If you have difficulty forming a seal with the face mask. If the patient requiring continued ventilatory support. When the patient has a high risk for aspiration provide an ETT or Combitube. Endotracheal Tube ETT. Requires additional instrument for insertion laryngoscope, glidescope, fiberoptic.
Laryngoscope blades average adult size : MAC 3 or 4, Miller 2 or 3. ETTs require mastery of technique for consistent appropriate placement. Average size of ETT for orotracheal intubation for adults is 7. The ETT is placed into the trachea, having direct visualization of the vocal cords.
Average depth of intubation:. Allows for positive pressure ventilation. Reduces risk of aspiration. Helps maintain placement of ETT.
Confirm placement of ETT. Secure in place of ETT. Esophageal-Tracheal Combitube. Gently advance the combitube into the mouth midline along the base of the tongue. Assure tube rotation of the combitube is following the curvature of the pharynx. The combitube provides ventilatory access irregardless of tracheal or esophageal intubation. Inflate the pharangeal cuff with ml of air.
Prevents leak through the nose and mouth. Helps secure placement. Inflate the tracheal cuff with 15ml of air. Prevents ventilation of stomach. Reduces risk of aspiration of stomach content. If placement not confirmed through esophageal tube:.
ACLS Algorithm Overview
Furthermore, these guidelines will be good through when the AHA meets again to update the guidelines. The articles will provide a complete review of the guideline changes released by the American Heart Association in their Executive Summary: American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This 6 minute video covers all the guideline changes listed below. The link provided above will provide you with a review of these changes which include changes in chest compression depth, rate, and quality. There are some minor changes directed toward health care providers and their use of BLS.
2020 ACLS Guideline Changes
Call us at Canada: Or mail support acls. These guidelines are current until they are replaced on October As a free resource for our visitors, this page contains links to sample algorithms for the main AHA Advanced Cardiac Life Support cases. See our website terms.
Algorithms for Advanced Cardiac Life Support 2020