Advance Cardiac

Life Support
Christian Gallardo, MD

CPR Milestones

1966
1973
1979
1985
1992
2000

1st conference on CPR

AHA Guidelines for ACLS
3rd conference
4th conference
5th conference. ILCOR
Guidelines 2000 for CPR and ECC
International Consensus on Science

Essentials of ACLS
CORE of ACLS Concepts
Cerebral Resuscitation is the
most important goal!
Returning the patient to the prearrested level of neurological
functioning
Cardio-Pulmonary-Cerebral
resuscitation (CPCR) had been
proposed to replace CPR

Focuses on Airway and

Ventilation, Basic CPR,
Defibrillation of Ventricular
fibrillation and Drugs

Essentials of ACLS
The probability of survival
declines with each passing minute
of cardiopulmonary compromise
Medical conditions that lead to
cardiac arrest must be identified
as quickly as possible (e.g. AMI)
The chain of survival applies in all
settings.
Good ACLS requires a careful
thought about when to start and
when to stop resuscitative efforts.

The Chain of Survival

Acute Coronary Syndrome (ACS)

52% deaths of AMI
occurs out of the
hospital within the 1st
hour after the onset of
symptoms
(chest
discomfort,
nausea,
SOB etc)

Stroke
Number 3 killer and
leading cause of severe,
long term disability
EMS provider should be
trained to suspect
stroke, rapid dispatch of
EMS and rapid delivery
to a hospital capable of
providing acute stroke
care

Adult BLS Algorithm

Adult BLS Algorithm

Adult BLS Algorithm

Push hard, push fast (rate of 100 compressions per minute),

allow complete chest recoil between compressions (Do not bend
elbows!!)
Compress in the center of the chest at the nipple line (2 fingers
width above the xyphoid process)
Compress the chest approximately 112 to 2 inches, using the
heel of both hands
Minimize interruptions in chest compressions

Adult BLS Algorithm

Automated External Defibrillator

Adult Basic Life Support

Recovery Position
For unresponsive adult victims who have
normal breathing
Should be stable, near a true lateral position,
with the head dependent and no pressure on
the chest to impair breathing

ACLS Algorithm

ACLS Pulseless Arrest Algorithm

ACLS Pulseless Arrest Algorithm

When using a bagmask device (ie, no advanced airway
is in place), the rescuer should deliver a tidal volume
sufficient to produce chest rise (approximately 6 to 7
mL/kg or 500 to 600 mL) over 1 second

ACLS Pulseless Arrest Algorithm

ACLS Pulseless Arrest Algorithm

ACLS Bradycardia Algorithm

ACLS Bradycardia Algorithm

ACLS Bradycardia Algorithm

ACLS Tachycardia Algorithm

ACLS Tachycardia Algorithm

ACLS Tachycardia Algorithm

ACLS Tachycardia Algorithm

ACLS Tachycardia Algorithm

ACLS Tachycardia Algorithm

Electrical
Cardioversion

Electrical Cardioversion Algorithm

Electrical Cardioversion Algorithm

Initial Energy Levels for
synchronized cardioversion:
50J: Atrial flutter and
SVT
100J: AF and
Monomorphic VT
Polymorphic VT (Torsade):
Synchronize is impossible, treat
as VF and deliver a high energy
synchronize shock (360J)

Defibrillation Injuries
Gibbs et al Am J Emerg Med 3/90
arm touching side of rail
hand contact with gel
checking femoral pulse
holding bag mask
thumb in contact with breast
leg touching stretcher
arc from paddle to electrode
hands over paddle electrode
crack in paddle
pts arm between MDs legs
discharge with paddles on head

-tingling arm x 30 min

-sore arm
-thrown clear of patient
-shock to fingers
-shock to hand
-shock to leg
-burn to hand and patient
-shock to arms
-PVCs, muscle spasms
-contusion to groin
-LOC x 5 min, burns

Case
Discussions
& Summary

Emergency Case 1
A 64 y/o male came in at the ER. Relative
claims that patient suddenly had lost of
consciousness 3 mins ago. What will you
do?
Assess patient: Get Vital Signs
Administer Oxygen
Hook to Defibrillator

Emergency Case 1
Patient has no pulse and is cyanotic. Then you
check the rhythm. It revealed:

Emergency Case 2
Patient comes in due to palpitations and chest
discomfort. BP= 60/40 CR= 189 RR= 28. You
administer oxygen and hooked the patient to a
defibrillator. Rhythm reveled:

Emergency Case 2
Initial Energy Levels for synchronized
cardioversion:
50J: Atrial flutter and SVT
100J: AF and Monomorphic VT

Emergency Case 3
Patient comes in due to palpitations and
shortness of breath. Patient is unconscious.
BP= 60/40 CR= 190 RR= 28. You administer
oxygen and hooked the patient to a defibrillator.
Rhythm reveled:

Torsade de Pointes

Emergency Case 3
Torsade de Pointes
Do synchronize cardioversion 360J (for
unstable patients).
Do it for 3 to 4x. If still not converted,
consider Magnesium.
How to give: 1-2 g diluted in 50 - 100 ml D5W
administer over 5 to 60 minutes followed by an
infusion of 0.5 1.0 g (4 to 8 mEq) per hour.

Emergency Case 4
Patient comes in due to chest heaviness of about 1 week.
BP= 100/60, RR= 18. Oxygen was given. ECG revealed:

Acute
Coronary
Syndrome
Algorithms

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm

Fibrinolytic Checklist

Fibrinolytic Therapy

Acute Coronary Syndrome

Acute Coronary Syndrome

Acute Coronary Syndrome

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm

Acute Coronary Syndrome Algorithm