ACLS

(Advanced Cardiac Life Support)
Oleh : M. Samsul Arifin Nur Hidayati Azar Peppy Tria Tita Luthfia S 0810710072 0810710088 0810710092 0810710107

Pembimbing : dr. Ali Haedar, SpEM

FK UNIV. BRAWIJAYA/RSU DR. SAIFUL ANWAR MALANG 2013

Introduction
• Cardiopulmonary arrest results in a rapid decline in oxygen delivery to the brain • Permanent disability or death results if the period of cerebral hypoxia lasts longer than 3 minutes

Introduction • Cardiopulmonary resuscitation (CPR) is the term used to describe the maintenance of adequate breathing and circulation in a patient who cannot do so for him.or herself • The aim of CPR is to restore respiration and adequate cardiac output as soon as possible to prevent death or permanent disability .

Effective advanced life support 5.Chain of Survival 1. Rapid defibrillation 4. Immediate recognition of cardiac arrest and activation of the emergency response system 2. Integrated post-cardiac arrest care Basic Life Support . Early CPR with an emphasis on chest compressions 3.

condition. events. Immediate Recognition & Activation EMS • Ensure that the scene is safe  Check for response (tapping and shouting) and any abnormal breathing • Activate EMS • Information: location. number.1. aid • Follow any instruction from dispatcher and hang up only when instructed • Lay rescuer should not check for pulse (assume cardiac arrest if unresponsive victim is not breathing normally) • Healthcare provider should take <10s to check for pulse .

Early CPR • Chest compression (forceful rhythmic applications of pressure over the lower half of sternum) • Place heel of the hand in lower half of sternum • Adult sternum should be depressed at least 2 inches/5cm • Allow chest recoil after every compression • Minimizing interruptions in compression • Avoiding excessive ventilation • Give at least 100 compression/minute • Deliver each rescue breath over 1 second (mouth to mouth or mouth to mask) • Compression : ventilation = 30:2 .2.

7 .

3. Early Defibrillation with AED • Retrieve an AED/ Automated External Defibrillator (if nearby & easily accessible) • Attach and turn the AED on • Follow the AED prompts • Resume chest compression immediately after the shock .

9 .

.

Advanced cardiovascular life support (ACLS) Interventions: Prevent cardiac arrest. Physiologic monitoring Survival and neurological outcome can be improved with integrated post cardiac arrest care 11 . Advanced airway management. Treat cardiac arrest. Improve outcomes of patient who achieve return of spontaneous circulation (ROSC) after cardiac arrest ACLS interventions build on the BLS foundation to further increase the likelihood of ROSC with: Drug therapy.4.

.

000) .Drugs Therapy Epinephrine (1:10.(drug class= Vasopressor) • 1 mg Rapid IV/IO push • 1st for all pulseless arrests Vasopressin (drug class= Vasopressor) • 40 Units IV/IO.can replace 1st or 2nd Epi Amiodarone • Used with ventricular rhythms (V-Fib / V-Tach) • Pulseless= 300 mg IV push or drip over 10 min • With pulse= 150 mg in 100 ml D5W drip over 10 min • Amiodarone Maintenance Drip= 450mg in 250 glass bottle of D5w Drip infusion @ 1mg/min .

Drugs Therapy Atropine • 0.always follow with NS bolus & give closest to heart • Warn patient and family about drug related symptoms: • Chest pressure. EKG pause .5mg IV/IO—for sinus bradycardia may repeat every 5 minutes for Max of 3 mg Adenosine • Used for SVT or stable monomorphic VT • 6mg rapidly—may repeat with a 12mg x 2. feeling faint.

given for Symptomatic Bradycardia refractory to Atropine • 2-10 mcg/kg/min Epinephrine Drip • 2-10 mcg/min • For symptomatic bradycardia refractory to Atropine .Drugs Therapy Dopamine Drip • Chronotropic drug.

Advanced Airway .

ACLS 2010 Guideline Review  Basic Life Support (BLS)  Cardiac Arrest  Bradycardia  Tachycardia  Acute Coronary Syndrome .

.

.

.

.

.

and hypothermia) • Transport the in-hospital post cardiac arrest patient to appropriate critical care unit capable of providing comprehensive post cardiac arrest care • Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest . Post Cardiac Arrest Care Objectives : • Optimize cardiopulmonary function and vital organ perfusion • Transport patient to appropriate hospital with comprehensive post-cardiac arrest treatment system (acute coronary intervention. neurological care. goal directed critical care.5.

5. Post Cardiac Arrest Care Subsequent Objectives : • Control body temperature to optimize survival and neurological recovery • Identify and treat acute coronary syndrome • Optimize mechanical ventilation to minimize acute lung injury • Reduce the risk of multiorgan injury and support organ function if required • Objectively assess prognosis for recovery • Assist survivor with rehabilitation services when required .

.

urine output. CXR. avoid hypotonic fluid . treat myocardial stunning • Neurological: serial neurological exam. treat ACS. mechanical ventilation • Hemodynamic: frequent blood pressure monitoring. non-enhanced CT scan • Metabolic: serial lactate exam. echocardiogram.Multiple System Approach to Post Cardiac Arrest Care • Ventilation: capnography. serum potassium exam. 12-lead ECG. core temperature measurement. pulse oxymetry. arterial line. treat hypotension • Cardiovascular: continuous cardiac monitoring. cardiac marker assessment. serum creatinine. BGA. serum glucose. EEG monitoring.