ACLS ALGORITHMSPrepared byTrevor ThomasNES Instructor

Advanced Cardiac Life Support

ACLS refers to the combine efforts of the health care worker to treat or to resuscitate the client, victim or patient from CARDIAC ARREST, STROKE and any other life threatening medical emergencies

What are the advanced skills that a health care worker should have?

Ability to manage airwayInitiate I/V accessRead and interpret the rhythmsKnowledge about emergencies pharmacologyDosage and calculation of drugs with routesHow to operate the Defibrillator

ContdThe health care worker who is running the code should be certified ( BLS & ACLS )Respiratory therapists efficacy Every team worker should know their responsibilities very well and keep their job efficient

NOW WE WILL GO WITH THE ALGORITHM CHART

SEQUENCEARE U OK? no responseABDOMINAL SCALINGFOR ( chest rise and fall )No movement ACTIVIATE EMERGENCYCHECK FOR PULSE (within 10 second)If no pulse start CPR ( 30:2 ) 5 cycle in 2 minsPulse present ( give rescue breath after every 5-6 sec till 2 minutes)After 2 mins check pulse Pulse present Check for breathing ( if present )Recovery position

On what components you have to emphasize?Pulse counting should not be more than 10 second.1-1=1000,2-1=1000 till 10-1=1000 with a unique speed (to manage time)If there is pulse only and no breath then what will you do?Give rescue breath with the pause of 5-6 second and then deliver breath for 2 mins, a total of 22-24 breaths

Normal QRS interval0.06 to 0.12 ( two to three small boxes )

Less than 0.06 Is know as Narrow ORS complex

Greater than 0.12Is know as Wide QRS complex

If patient is asymptomatic in both the cases what will be your next step?

Vagal ManeuversInj. AdenosineBeta BlockersInjection Lopressor up to 20-30mg4. Calcium Blockers Injection Isoptin/ Verampril5. Synchronized shock in narrow complex if unstable (symptomatic)

if patient is symptomatic and having narrow QRS complex so what will be your next step?SYNCHRONIZED SHOCK:ABOUT 50-100 JOULES

If patient is symptomatic and having wide QRS complex( irregular rhythm) so then?UNSYNCHRONIZED SHOCKYOU START FROM 200 JOULES

FOR VT/VFPoint to remember:Give 1st shock of 200 jouleResume CPR for 2 minutesGive 2nd shock of same joule or higherAfter giving 2nd dose of shock now you can give vasopressin or epinephrine 1mg (with the duration of 3-5 mins only for epi)

continue4. Give 3rd shock of same joule or higher. After giving 3rd shock you can give Injection Amidrone 300mg in stat and the rhythm is still the same you can repeat the dose of 150mg or I/V infusion5. If you see torsades on the monitor so then give Inj. Magnesium

FOR ASYSTOLE OR PEAImmediate start CPR after confirming the rhythmIf you have I/V access give I/V vasopressin 40 U or to replace the first and second doses of epinephrine (a gap of 6-10 minutes)Continue the sequence of BLS as per guidance given by AHA.

FIVE Hs and FIVE TsHypovolemiaHypoxiaHydrogen ionHypo/Hyper kalemiaHypoglycemia ( it is removed but still considered)HypothermiaToxins

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