ACLS

Notes on: Advanced Cardiac Life Support

Elements of Advanced Cardiac Life Support (ACLS)
1. Basic Life Support (BLS)
2. The use of adjunctive equipment and special techniques for ventilation and artificial circulation
3. Cardiac monitoring of arrythmias
4. Establishment of IV access line
5. Definitive therapy to treat acidosis, hypotension, and arrythmias
6. Defibrillation
7. Ancillary resuscitation care

Core Concepts
A. Brain
1. decreased cerebral perfusion --> cerebral hypoxia
2. prolonged hypoxia --> infarction and ultimately cell death
3. brain tissue cells are amitotic thus incapable of regeneration
4. the term "cardiopulmonary-cerebral resuscitation (CPCR)" is proposed

B. Patient
1. is the airway adequate?
2. are ventilations effective?
3. what could have caused this arrest?
4. what else could be wrong?
5. what am I missing?

C. BLS
A=airway
B=breathing
C=circulation
D=defibrillation

D. Time
> length of time from arrest to start resuscitation is inversely proportional to success rate of survival

E. Cause
> identify medical conditions that lead to cardiac arrest ASAP
>>>>> "Man down, ..."
>>>>> "Victim unresponsive! ..."
>>>>> think of the heart...
>>>>> think of acute MI...
>>>>> think of ventricular fibrillation!...

F. Post- Resuscitation Care
1. Continue to provide appropriate evaluation and therapy in teh period immediately after restoration of a spontaneous circulation
2. The ACLS recommendations during the post-resuscitation
3. Pd. assume that invasive hemodynamic monitoring is not available

G. Chain of Survival
1. Early Access- a cardiac emergency must be recognized and responded to
2. Early CPR- some efforts at opening the airway, ventilation and blood circulation must occur ASAP
3. Early Defibrillation- identification and treatment of VF is the single most impotant intervention
4. Early ACLS- advanced airway control and rhythm, appropriate IV medications must be administered rapidly

H. Phased-Response Approach
> Every resuscitative attempt possess a structure, a time course, and a rich variety of intermediate stages. It also produces psychological effects on the rescuer.
1. anticipation by rescuers
2. entry into the resuscitative efforts
3. the resuscitative effort itself
4. maintenance of the patient
5. family notification

I. Indications
1. Respiratory arrest
2. Cardiac arrest
>> cardiovascular collapse
>> cardiac standstill
>> VF

* Contraindications
>A patient with a terminal, hopeless illness
>When the decision to allow death to proceed from national causes has already been made
>An obviously dead victim (with decapitation or when rigor mortis has begun)

J. Expected Deaths and Futile Resuscitation
1. For many people, the last beat of their heart is the last beat of their heart.
2. Resuscitative efforts may be inappropriate, futile, undignified, and demeaning t both the patient and the rescuers.
3. Good ACLS requires careful thought about when to start and when to stop resuscitative efforts.


Note: Notes were taken from my own nursing lecture notes. Information may not be accurate. Please refer to other available resources.