Advanced Cardiac Life Support step 1 check for responsiveness tap &

Overview and Protocol - ACLS Shout are you alright then scan the chest for
movement here you're looking for absent or
AHA
abnormal breathing this can be no
cardiovascular disease strikes in every
breathing or only gasping he's not
nation around the world from sudden
responding and he doesn't he's not
cardiac arrest to the disabling effects of
breathing activate the emergency response
acute coronary syndromes and acute
system and get an AED if the patient is
ischemic stroke cardiovascular disease
unresponsive then move
remains a leading cause of disability and
to step two activate the emergency
death in many parts of the world
response system and get an AED step 3
understanding and activating the systems of
circulation check the carotid pulse do not
care developed by the American Heart
spend more than 10 seconds checking for a
Association can help improve survival rates
pulse if you cannot feel
and may even prevent cardiac arrest you
a pulse within 10 seconds start CPR
play a pivotal role in
immediately give cycles of 30 chest
providing high quality cardiovascular care
compressions followed by 2 ventilations
what you do matters what you learn can
step 4 defibrillation as soon as possible
save lives welcome to the American Heart
attach an AED or defibrillator and if
Association's BLS and ACLs surveys video
indicated deliver a shock if you've had any
will be demonstrating the latest life-saving
training on BLS you'll notice the sequence
interventions and the skills necessary to
of steps has changed you no longer look
successfully manage arrest peri-arrest acs
listen and feel for breathing before
and stroke patients most of the instruction
delivering two breaths the ABCD sequence
will take place here in the American Heart
often delayed chest compressions as the
Association's training lab where we can
healthcare provider tried to open the airway
successfully demonstrate and practice
and deliver ventilations by changing the
those important skills you of course will
sequence and giving chest compressions
have the chance to practice skills in learning
first more patients may achieve return of
stations in your classroom in this segment
spontaneous circulation or roske however if
of the course you'll be learning to systematic
you determine that the patient is not
approaches developed by the American
breathing normally but has a pulse bypass
Heart Association for treating patients the
chest compressions and support the patient
basic life support or BLS survey and the
with rescue breathing delivering one breath
advanced cardiovascular life support or
every five to six seconds the critical
ACLs survey by adhering to these steps you
concepts for high quality BLS are push hard
can better manage patients when deciding
and push fast allow complete chest recoil
which survey to use to treat a patient start
after each compression minimize
with a step we all do automatically visually
interruptions in chest compressions switch
assess if the patient is conscious or
providers about every two minutes to avoid
unconscious if the patient is conscious
fatigue and avoid excessive ventilations let's
move to the ACLs survey which we'll review
take a look at how the BLS steps come
in a
together in an arrest situation morning
moment for unconscious patients you'll use
gentlemen don't want a joke good morning
the BLS survey which has four steps
sorry it's so early yes thank you so much all
right now if you look at the
graphs you'll see that the new programs
have implemented haven't really kicked
in yet a 57 year old man is experiencing
many of the warning signs of acute
coronary syndromes or ACS with chest
discomfort indigestion and feeling faint
Daniel are you okay you don't look so
good
I'm fine probably gonna go home early
though oh that is your scenario now
begin sir are you all right
he's unresponsive and not breathing
activate the emergency response system
and get an AED 1 2 3 4 5 6 7 8 9 10 11
12 13 14 15 16 17 18 19 20 21 to 23 24
25 26 seven twenty eight twenty nine
thirty one two three
the co team is on the way I've got the
AED 8 9 10 11 12 13 14 15 16 17 attach
pads to patients bare chest 25 26 27 28
29 plug in pads connector 1 2 3 4 5 6 7
8 9 10 11 12 13 14 15 16 17 18 19 20 21
a two analyzing heart rhythm do not
touch the patient shock needed one two
charging 4 5 6 7 8
stay clear of patient deliver shock now
to the patient press the flashing button
shot down 3 1 2 3
shocking jaw are never delivered begin
CPR start with compressions high-quality
BLS is the foundation for saving lives
following sudden cardiac arrest if these
steps are performed rapidly and well the
patient's chance of survival increases
the effectiveness of advanced life
support measures depends on high quality
BLS there's a reason that these steps
are called life support when a patient
goes into cardiac arrest one of the
common presenting rhythms is ventricular
fibrillation or VF the heart is
quivering but not effectively pumping
blood to vital organs high quality chest
compressions maintain blood flow to
vital organs especially the heart chest
compressions are the highest priority in
the first minutes of cardiac arrest
one way to measure the effectiveness of
chest compression is with coronary
perfusion pressure coronary perfusion
pressure during CPR must reach at least
10 millimeters of mercury
to be 10
achieved the return of spontaneous
circulation or Ross as chest
compressions begin it takes several
compressions to raise the coronary
perfusion pressure to a level adequate
to supply blood to the heart the higher
the coronary perfusion pressure during
CPR the better the survival rate for the
patient when health care providers
interrupt chest compressions perfusion
pressure Falls dramatically and remains
very low until compressions are
restarted because coronary perfusion
pressure measurements are not readily
available during a resuscitation attempt
health care providers can monitor CPR
quality with wave form capnography and
intra-arterial relaxation pressures will
discuss the details of wave form
capnography later in this course
specific patients with an end tidal co2
reading of less than 10 millimeters of
mercury may not achieve roske for
intra-arterial relaxation pressures a
reading of less than 20 millimeters of
mercury indicates ineffective
compressions to perform high quality
chest compressions you should push hard
and push fast push hard means that you
should compress the chest at least two
inches and allow complete chest recoil
after each compression if the chest is
not completely recoil coronary perfusion
will remain low push fast means to
deliver at a rate of at least 100
compressions per minute scientific
studies show that the number of chest
compressions delivered is an important
direct determinant of Ross and
neurologically intact survival it can be
difficult to maintain such a vigorous
pace which is why the American Heart
Association recommends that rescuers
switch roles after 2 minutes or 5 cycles
of 30 compressions and 2 ventilations
high-quality CPR minimizes interruptions
and chest compressions so more chest
compressions are delivered resulting in
better perfusion studies show that even
health care providers interrupt
compressions far too often and for too
long in some cases spending 25 to 50
percent of a code without delivering
chest compressions the circular BLS
algorithm emphasizes the two-minute
period of compressions and ventilations
punctuated by a break of no more than 10
seconds to assess the patient and to
defibrillation another key step in BLS
is providing rapid defibrillation if
indicated although CPR can provide vital
oxygen and blood circulation
defibrillation is essential to
establishing a normal rhythm in patients
with a lethal shockable rhythm the
delivery of an electrical shock from a
defibrillator briefly stops all
electrical activity in the heart if the
heart is still viable its normal
pacemakers may resume electrical
activity that ultimately results in a
perfusing rhythm or roske
survival rates are highest when rescuers
provide CPR immediately and
defibrillation for initial shockable
rhythm occurs within 3 to 5 minutes for
a patient with the shockable rhythm
every minute that ticks by without a
shock reduces the chance of survival
let's review the four steps of the BLS
survey step one check responsiveness tap
and shout and scan the chest for
movement step 2 activate the emergency
response system and get an AED step 3
circulation check for a carotid pulse if
you cannot feel a pulse within 10
seconds support circulation by giving
cycles of 30 chest compressions followed
by two ventilations step four
defibrillation as soon as possible
connect an AED or defibrillator and if
indicated deliver a shock the best
chance of a patient surviving an episode
of cardiac arrest depends on high
quality BLS in some cases BLS results in
roske but sometimes cardiac arrest
persists requiring you to continue with
more advanced invasive measures that's
the time to use the ACLs survey another
time to use the ACLs survey is if a
patient is conscious but needing
treatment for ACS you can easily
remember the steps of the ACLs survey by
thinking ABCD a stands for airway for
unconscious patients healthcare
providers should maintain a patent
airway and consider inserting an
advanced airway device the resuscitation
team must ensure proper placement of an
advanced airway if the team chooses an
endotracheal tube insertion is the
method of airway control
a form capnography should be used
conscious patients can often maintain
the integrity of their own airway and
health care providers need only ensure
patency by providing suctioning if
needed
B represents breathing for patients
experiencing cardiac arrest health care
providers should provide two
ventilations with the bag mask after
every 30 chest compressions
after inserting an advanced airway
health care providers should continue
ventilations by providing one breath
every six to eight seconds or eight to
ten breaths per minute if the patient is
not in cardiac arrest health care
providers should assist ventilation is
needed at a rate of one breath every
five to six seconds or 10 to 12 breaths
per minute if the patient does not
require assisted ventilation health care
providers can support the patient by
administering oxygen as needed c
involves supporting the patient's
circulatory status attached ECG leads
obtain intravenous or IV access or
interosseous or IO access and give
appropriate drugs to manage rhythms
finally D stands for differential
diagnosis search foreign treat
reversible causes or symptoms by
reviewing the h's and t's although these
steps are listed in progressive order
the resuscitation team often performs
them simultaneously with ACLs patient
care is organized around two minute
periods of high-quality CPR when the two
minutes have ended that's the time to
quickly assess the patient with a rhythm
or pulse check and provide
defibrillation if necessary the pause
should also be used to rotate
compressors preparing as a team for
these pauses and choreographing your
movements improves patient care
remember
iha wants these pauses in CPR to be 10
seconds or less let's return to our case
in the training lab to watch how
providers incorporate the ACLs survey
into a scenario where a patient is
suffering from persistent VF the case
progresses with the arrival of a team of
advanced health care providers
seven eight nine ten eleven twelve
thirteen fourteen fifteen okay what have
we got the patient suddenly collapsed
during a meeting we started CPR
immediately and we've shocked the
patient once one minute 48 seconds ago
followed by immediate CPR we've got the
ECG monitoring attached now it's now 2
minutes from our last shock
okay let's analyze this rhythm stand
back everyone hold chest compressions
okay we've got persistent VF resuming
compressions one two let's deliver a
second shock at 150 joules Dana let's
establish IV access and be prepared to
administer one milligram of epinephrine
IV charging clear the patient shocking
on three one two three shocking shock
delivered
resuming compressions one two three what
do we know about the possible causes
first responder said that the patient
complained of chest pain before he
collapsed houses airway I was getting in
chest rise with a bag mask but now I'm
getting significant resistance okay
let's go ahead and insert an advanced
airway
Dana once that IV is established you
have one milligram of epinephrine and
flush with a 20 milliliters saline bolus
okay one milligram epinephrine with a 20
milliliter saline bolus the idea started
and one milligram epinephrine and the IV
is flushed okay thank you let's go ahead
and prepare 300 milligrams of amiodarone
I'll let you know if and when to give it
okay drawing 300 milligrams of
amiodarone the laryngeal tube is in fine
I've got good bilateral breath sounds
wave poem capnography is reading 20
millimeters of mercury okay great we're
gonna continue chest compressions at a
rate of at least 100 beats per minute
let's give one breath every six to eight
seconds and avoid excessive ventilation
how long since our last shot it's almost
two minutes okay let's get ready to
switch compressors we're gonna stop and
analyze two minutes okay let's analyze
okay we have an organized rhythm with
regular complexes do we have a pulse
we've got a week but palpable pulse in
tidal co2 is now up to 50 millimeters of
mercury okay great job everyone we're
gonna start post cardiac arrest care
I'll need a blood pressure a set of labs
pulse ox and let's get a 12-lead ECG
successful resuscitation following
cardiac arrest requires an integrated
set of coordinated actions which are
represented by the links in the adult
chain of survival these links include
the immediate recognition of cardiac
arrest and activation of the emergency
response system early CPR rapid
defibrillation effective advanced life
support an integrated immediate post
cardiac arrest care healthcare providers
implement this chain of survival through
BLS and ACLs surveys the BLS survey
stresses activation of the emergency
response system early CPR and rapid
defibrillation the ACLs survey airway
breathing circulation and differential
diagnosis integrates advanced techniques
such as advanced Airways quantitative
waveform capnography appropriate drug
delivery and the diagnosis and treatment
of reversible causes successfully
following the American Heart Association
systematic approach to assessing and
treating patients with the BLS and ACLs
surveys can make a difference what you
learn can save lives