Basic life support and

advanced cardiovascular life support

Dr. Aftab Ahmed

Basic life support (BLS) and advanced cardiac life
support (ACLS) are different levels of emergency care.
BLS can be learned and practiced by the general
public, and primarily includes;
a)Cardiopulmonary resuscitation (CPR),
b)Sometimes the use of automatic external
defibrillators (AEDs).
ACLS typically is used only by healthcare
professionals and includes the use of medications to
treat emergency heart-related conditions and strokes.
 Basic Life Support
According to AHA 2010 guidelines for ACLS and BLS
The BLS survey have changed from ABC i.e.
Airway
Breathing
Circulation TO
 This is an outline of the 4 steps
in the BLS Survey :

 (1) Check responsiveness by

tapping and shouting, “Are you
all right?” Scan the patient for
absent or abnormal breathing
(scan 5-10 seconds).
 (2) Active emergency
response system and obtain a
AED. If there is more than one
rescuer, have the second person
activate emergency response
and get the AED/Defibrillator.
(3) Circulation: Check for a
carotid pulse. This pulse
check should not take more
than 5-10 seconds. If no pulse
is palpable begin CPR.

(4) Defibrillation: If there is

no pulse, check for a
shockable rhythm with the
AED or defibrillator as soon
as it arrives.
The rescuer may provide
breaths by either exhaling
into the subject's mouth or
nose or through ambu bag.

Current recommendations
place emphasis on high-
quality chest compressions
over artificial respiration.

Its main purpose is to restore

partial flow of oxygenated
blood to the brain and heart.
A universal compression to ventilation ratio of
30:2 is recommended.

With children, if at least 2 trained rescuers are

present a ratio of 15:2 is preferred.

If an advanced airway such as an endotracheal

tube or laryngeal mask airway is in place delivery
of ventilations should occur without pauses in
compressions at a rate of 8–10 per minute.
Recommended compression depth in adults and
children is at least 5 cm (2 inches) and in infants it is
4 cm (1.5 inches).
In adults rescuers should use two hands for the chest
compressions, while in children they should use one,
and with infants two fingers (index and middle
fingers).
CPR serves as the foundation of successful
cardiopulmonary resuscitation, preserving the victim
for defibrillation and advanced life support.
Defibrillation is only effective for certain heart
rhythms, namely ventricular fibrillation or
pulseless ventricular tachycardia, rather than
asystole or pulseless electrical activity.

CPR is generally continued until the patient has a

return of spontaneous circulation (ROSC) or is
declared dead.
Studies have shown that immediate CPR followed
by defibrillation within 3–5 minutes of sudden VF
cardiac arrest dramatically improves survival.
The places where CPR training is widespread and
defibrillation by EMS personnel follows quickly,
the survival rate is about 20 percent for all causes
and as high as 57 percent if a witnessed
"shockable" arrest .
 BLS healthcare provider algorithm

Berg R A et al. Circulation. 2010;122:S685-S705

Copyright © American Heart Association, Inc. All rights reserved.
Advanced Cardiac Life Support
 The ACLS Survey uses the ABCD
model to systematize the ACLS
process. The ABCD’s of the ACLS
Survey are:

(A) Airway: Maintain airway and

use advanced airway if needed.
 Ensure confirmation of placement
of an advanced airway and secure
the advanced airway device.

(B) Breathing: Give bag-mask

ventilation, provide supplemental
oxygen, and avoid excessive
ventilation..
C) Circulation: Obtain IV
access, attach ECG leads,
identify and monitor
arrhythmias, giving fluids if
needed, and use
defibrillation if appropriate.

(D) Differential diagnosis:

Look for reversible causes
and contributing factors for
the emergency.
 ACLS often starts with
analyzing the patient's heart
rhythms with a manual
defibrillator.
 In contrast to an AED in BLS,
where the machine decides
when and how to shock a
patient, the ACLS team leader
makes those decisions based on
rhythms on the monitor and
patient's vital signs.
 AHA 2010 guidelines for
BLS and ACLS
New ACLS guidelines focus on BLS as the core component of
ACLS.
It also include end tidal CO2 monitoring as a measure of
CPR effectiveness, and as a measure of ROSC.
Other changes include the exclusion of Atropine
administration for pulseless electrical activity (PEA) and
asystole.
CPR (for ACLS and BLS) was reordered from "ABC" to "CAB"
(circulation, airway, breathing) to bring focus to chest
compressions.
 Algorithms
The current ACLS guidelines are set into several
groups of "algorithms" - a set of instructions that
are followed to standardize treatment, and
increase its effectiveness.
These algorithms usually come in the form of a
flowchart, incorporating 'yes/no' type decisions,
making the algorithm easier to memorize.
Pulseless Arrest Algorithm

Bradycardia Algorithm

Tachycardia Algorithm
 Pulseless Arrest Algorithm
There are 4 rhythms that produce pulseless arrest.

A) Pulseless ventricular tachycardia (VT)

B) Ventricular fibrillation (VF)

C) Asystole

D) Pulseless electrical activity (PEA).

 VF/Pulseless VT
Treatment of Ventricular
Fibrillation (VF) and
Pulseless Ventricular
Tachycardia (VT) is
included in the Pulseless
Arrest Algorithm.
VF and pulseless VT are
shockable rhythms and
treated in similar fashion.
Asystole and PEA are also
included in the pulseless
arrest algorithm but are
nonshockable rhythms.
Key points
Pulseless arrest algorithm:

High-quality CPR should be performed until the

defibrillator is attached the patient.
Interruptions in chest compressions should be kept to a
minimum.
Rapid use of the defibrillator should be emphasized.
If possible, use a manual defibrillator over an AED.
No longer are stacked shocks used.
CPR is resumed for 5 cycles between each shock.
 Defibrillation and the Shock
Most defibrillators used
today are biphasic.
Biphasic means that the
electrical current travels
from one paddle to the other
paddle and then back in the
other direction.
The biphasic shock also
requires less energy to
restore normal heart rhythm
and is believed to reduce skin
burns and cellular damage to
the heart.
For VF and/or pulseless VT, use dose of 120-200
Joules to shock.

To ensure safety during the shock, providers

should always announce the following statement,
“I am going to shock on three. One, I’m clear…
Two, you’re clear…Three, everybody is clear.”
 Asystole and Its Treatment in ACLS
Asystole is defined as a cardiac arrest rhythm in
which there is no discernible electrical activity on
the ECG monitor.
Asystole is sometimes referred to as a “flat line.”
Confirmation that a “flat line” is truly asystole is
an important step in the ACLS protocol.
Fine VF can appear to be asystole, and a “flat line”
on a monitor can be due to operator error or
equipment failure
The following are common causes of an
isoelectric line that is not asystole:
 loose or disconnected leads;
 loss of power to the ECG monitor;
 low signal gain on the ECG monitor.
Asystole for many patients is the result of a
prolonged illness or cardiac arrest, and prognosis
is very poor.
Positive outcome depends on underlying cause
and emergent treatmentent.
The H’s and T’s of ACLS should be reviewed to
identify any underlying cause that could have
precipitated the asystole.
 PEA (Pulseless Electrical
Activity)
 PEA is defined as any organized
rhythm without a palpable pulse
and is the most common rhythm
present after defibrillation. .
 Positive outcome of an attempted
resuscitation depends primarily on
two actions:
1. Providing effective CPR;
2. Identification and correction of
the cause of PEA
 Atropine is no longer
recommended for the treatment of
PEA per the 2010 ACLS guidelines.
There are 2 medications used in the PEA algorithm,
epinephrine and vasopressin.
These medications should be given while maintaining
high-quality CPR. 1 milligram of epinephrine is given IV or
IO every 3-5 minutes.
40 Units of vasopressin can be given IV or IO to replace
the first or second dose of epinephrine.
One easy way to remember the most common causes of
PEA as well as other cardiac emergencies is the H’s and T’s
of ACLS.
 Bradycardia Algorithm
The major ECG rhythms classified as bradycardia
include:
Sinus Bradycardia
First-degree AV block
Second-degree AV block
Type I —Wenckenbach/Mobitz I
Type II —Mobitz II
Third-degree AV block complete block
2010 AHA Update: For symptomatic bradycardia or
unstable bradycardia IV infusion chronotropic agents
(dopamine & epinephrine) is now recommended as an
equally effective alternative to external pacing when
atropine is ineffective.
Atropine: The first drug of choice for symptomatic
bradycardia. Dose in the Bradycardia ACLS algorithm is
0.5mg IV push and may repeat up to a total dose of 3mg.
Dopamine: Second-line drug for symptomatic
bradycardia when atropine is not effective. Dosage is 2-10
micrograms/kg/min infusion.
Epinephrine: Can be used as an equal alternative to
dopamine when atropine is not effective. Dosage is 2-10
micrograms/min.
 Bradycardia Algorithm
 The decision point for ACLS
intervention in the bradycardia
algorithm is determination of
adequate perfusion.
 For the patient with adequate
perfusion, you should observe and
monitor.
 If the patient has poor perfusion,
preparation for transcutaneous
pacing should be initiated, and an
assessment of contributing causes
(H’s and T’s) should be carried out.
 Transcutaneous pacing (TCP)
 Preparation for TCP should be
taking place as atropine is being
given.
 If atropine fails to alleviate
symptomatic bradycardia, TCP
should be initiated.
 Ideally the patient should
receive sedation prior to pacing,
but if the patient is deteriorating
rapidly, it may be necessary to
start TCP prior to sedation.
 For the patient with
symptomatic bradycardia with
signs of poor perfusion,
transcutaneous pacing is the
treatment of choice.
 Tachycardia Algorithm
Tachycardia/tachyarrhythmia is defined as a
rhythm with a heart rate greater than 100 bpm.
An unstable tachycardia exists when cardiac
output is reduced to the point of causing serious
signs and symptoms.
Serious signs and symptoms commonly seen with
unstable tachycardia are: chest pain, signs of
shock,, altered mental status, weakness, fatigue,
and syncope
One important question you may want to ask is:
“Are the symptoms being caused by the
tachycardia?” If the symptoms are being caused by
the tachycardia than treat the tachycardia.
 Causes

The most common causes of tachycardia that

should be treated outside of the ACLS tachycardia
algorithm are dehydration, hypoxia, fever, and
sepsis. There may be other contributing causes
and review of the H’s and T’s of ACLS should take
place as needed.
Administration of OXYGEN and NORMAL
SALINE are of primary importance for the
treatment of causative factors of sinus tachycardia
and should be considered prior to ACLS
intervention.
Once these causative factors have been ruled out or
treated, invasive treatment using the ACLS tachycardia
algorithm should be implemented.
Associated Rhythms
There are several rhythms that are frequently associated
with stable and unstable tachycardia these rhythms
include:
Atrial fibrillation
Atrial flutter
Supraventricular tachycardia (SVT)
Monomorphic VT
Polymorphic VT
Wide-complex tachycardia of uncertain type
 Tachycardia Algorithm
Asked when initiating the
ACLS tachycardia
algorithm is: “Is the
patient stable or
unstable?”
Patients with unstable
tachycardia should be
treated immediately with
synchronized
cardioversion.
If a pulseless tachycardia is
present patients should be
treated using the pulseless
arrest algorithm.
 Tachycardia Algorithm
Patients with stable
tachycardia are treated
based upon whether they
have a narrow or wide
QRS complex.
The following flow
diagram shows the
treatment regimen for
stable tachycardia with
narrow and wide QRS
complex.
Stable (narrow QRS
complex) → vagal
maneuvers → adenosine
(if regular) → beta-
blocker/calcium channel
blocker → get an expert
Stable
(wide/regular/monomor
phic) → adenosine →
consider antiarrhythmic
infusion → get an expert
 ACLS Ventilation
There are 5 basic airway skills
used to ventilate a patient.

1.) Head tilt-chin lift;

2.) Jaw thrust without head
extension for possible
cervical spine injury;
3.) Mouth-to-Mouth
ventilation;
4.) Mouth-to-Barrier device
(using a pocket mask); and
5.) Bag-mask ventilation.
 Advanced Airways
Advanced Airways used
during ACLS include
Combitube, LMA
(Laryngeal mask airway),
and ET tube (endotracheal
tube).
Once an advanced airway
is in place, chest
compressions are no
longer interrupted for
ventilations. 1 breath
should be given every 6-8
seconds (8-10 breaths per
minute).
 Capnography (PETCo2)
Device placed between ET
tube and ambu and
hooked to monitor end
tidal Co2
Measures adequate
coronary perfusion
Best indicator of ET tube
placement
During ET suctioning
withdraw no longer than
10 sec
 Oxygenation and Ventilation
Ventilation Oxygenation
(capnography) O2 (oximetry)

Cellular
Metabolism
CO2
 Pulse Oximetry
Sensors

Pulse Oximetry Waveform

 Ventilation
Measured by the end-tidal CO2
Partial pressure (mmHg) or volume (% vol) of CO2 in
the airway at the end of exhalation
Breath-to-breath measurement provides information
within seconds
Not affected by motion artifact, poor perfusion or
dysrhythmias
Oxygenation versus Ventilation
Now hold your breath
Note what happens to SpO2
the two
EtCO2
waveforms

How long did it take the EtCO2 waveform to go flat line?

How long did it take the SpO2 to drop below 90%?

Oxygenation and Ventilation
Oxygenation Ventilation
Oxygen for metabolism Carbon dioxide
SpO2 measures from metabolism
% of O2 in RBC EtCO2 measures
Reflects change in exhaled CO2 at
oxygenation within point of exit
5 minutes Reflects change in
ventilation within
10 seconds
• During ACLS- target Co2 level is 10-15 (mmHg)
• ROSC(return of spontaneous circulation)-
target Co2 level is 35-40 (mmHg)
45
Normal

Hyperventilation
45

0
Hypoventilation
45

0
Bronchospasm
45

0
Induce Hypothermia
Patient with ROSC and comatose
Indications:
 i. Unresponsive pt not responding to commands
after ROSC
 ii. Estimated time from arrest to ROSC is less
than 60 minutes
Induce therapeutic hypothermia protocol
which lowers body temp to reduce the risk of
ischemic injury to brain following a period of
insufficient blood flow
Goal
Cool for 24 hours to goal temp of 32-34 C
DECISION MAKING AFTER ROSC

Comatose with glassgow motor< 6

No alternative reason for coma
No uncontrolled bleeding
Hemodynamically stable,no uncontrollable
dysrhythmias
Absence of severe MODS and sepsis
Full code status prior to event
Pre arrest cognition not meaningfully impaired,
---prolonged arrest time > 60minutes
---pregnancy ,consult maternal fetal medicines
Monitor core temperature
 Esophagus, or central venous/pulmonary arterial probe
Ice packs and cooling mats
 Effective, but difficult to control rate of temperature change
 Overcooling is dangerous
Endovascular cooling allows for gradual reduction in temp,
maintainence at desired temp and prevents over cooling
Blood pressure maintenance
I/V 1-2 liters of cold (4 C)NS or RL

In pulmary edema use .5 to 1 L cold saline lavage

For ACS patients take to cath lab with hypothermia

induction.
Devices
Contraindication

Pt responding to verbal commands

Pregnant
DNR
Recent head trauma or traumatic arrest
In coma from other causes like
overdose, stroke, etc
Temp already less than 93.2 F
 Review of Respiratory Arrest
Respiratory Arrest simply means cessation of breathing.
In ACLS, respiratory arrest typically means that a patient’s
respirations are completely absent or inadequate to
maintain oxygenation, but a pulse is present.
Management of respiratory arrest includes the following
interventions:
a)Give oxygen
b)Open the airway
c)Provide basic ventilation
d)Provide respiratory support with the use of
e)Artificial airways (OPA and NPA)
f)Suction to maintain a clear airway
g)Maintain airway with advanced airways
The next steps in ACLS are
insertion of intravenous (IV)
lines and placement of various
airway devices
Suctioning
If the airway is being maintained with the basic
airway skills listed above, blood, secretions, and
vomit become the primary causes of an obstructed
airway in the unconscious patient. Suctioning
should be used to clear the airway if it becomes
occluded with these body fluids.
Limit oral and endotracheal suctioning to 10
seconds or less to reduce the risks of hypoxemia.
Monitor for changes in heart rate as
oropharyngeal suctioning can cause vagal
stimulation resulting in bradycardia.
Bag-Mask ventilation
Bag-Mask ventilation is the most common method of
providing positive-pressure ventilation. Both the
oropharyngeal airway and the nasopharyngeal airway may
be used as adjuncts to improve effectiveness of patient
ventilation. The oropharyngeal airway may only be used
on the unconscious patient because it can stimulate
gagging and vomiting in a conscious patient. The
nasopharyngeal airway may be used on the unconscious
patient or on the semiconscious patient and is also
indicated if a patient has massive trauma around the
mouth or wiring of the jaws.
 Bradycardia vs. Symptomatic Bradycardia
 Bradycardia is defined as any rhythm disorder with a heart rate less than 60 beats per
minute. (Typically it will be <50/min) This could also be called asymptomatic
bradycardia. Bradycardia can be a normal non-emergent rhythm. For instance, well
trained athletes may have a normal heart rate that is less than 60 bpm.
 Symptomatic bradycardia however is defined as a heart rate less than 60/min that elicits
signs and symptoms, but the heart rate will usually be less than 50/min. Symptomatic
bradycardia exists when the following 3 criteria are present: 1.) The heart rate is slow; 2.)
The patient has symptoms; and 3.) The symptoms are due to the slow heart rate.
 Functional or relative bradycardia occurs when a patient may have a heart rate within
normal sinus range, but the heart rate is insufficient for the patients condition. An
example would be a patient with an heart rate of 80 bpm when they are experiencing
septic shock.
 Bradycardia Pharmacology
 There are 3 medications that are used in the Bradycardia ACLS Algorithm. They are
atropine, dopamine (infusion), and epinephrine (infusion). More detailed ACLS
pharmacology information can be found here.
 VF treated with CPR/AED
 Ventricular Fibrillation which occurs in the out-of-hospital setting should be treated with CPR and an AED. Effective
CPR and early defibrillation are the key to positive outcomes for the unresponsive patient who is in ventricular
fibrillation.
 This ACLS scenario will usually involve one or two rescuers in an out-of-hospital setting. Ideal equipment would be
an AED and a pocket mask. Rapid assessment and treatment using the CAB sequence of BLS should be performed as
the first intervention.
 CPR
 CPR will be initiated if the patient does not have a palpable pulse or if it is undetermined if the patient has a pulse.
Delaying CPR reduces the chances of a successful resuscitation thus, it is better to give unnecessary CPR than to delay
CPR in questionable cases.
 CPR may be needed after successful defibrillation since spontaneous rhythms after defibrillation may not always
produced adequate perfusion for several minutes.
 The AED
 AED’s should be used when the following 3 clinical findings exist:
 Patient is not responsive
 Patient is not breathing
 Patient has no pulse
 Most AEDs or External Automated Defibrillators provide voice instructions from the point of turning on the machine.
The machine will perform the rhythm interpretation and will also instruct you when to shock the patient. It should
also instruct you to resume CPR when necessary.
 While using the AED, BLS should be maintained by giving high quality chest compressions and using basic airway
skills such as the head-tilt chin lift and mouth-to-barrier device resuscitation.
 Emergencies are treated in the following order: Check patient responsiveness, activate EMS, and get the AED, then
perform CABD’s of the BLS Primary Survey.
Conclusion
BLS Survey
 Check responsiveness &breathing
 Activate EMS/Code/AED/defib
 Check Pulse no longer than 10 sec
 Start CPR
 Defib/shock if needed
 ACLS Cardiac Arrest Algorithm.

Neumar R W et al. Circulation. 2010;122:S729-S767

Copyright © American Heart Association, Inc. All rights reserved.
 Bradycardia Algorithm.

Neumar R W et al. Circulation. 2010;122:S729-S767

Copyright © American Heart Association, Inc. All rights reserved.
 Tachycardia Algorithm.

Neumar R W et al. Circulation. 2010;122:S729-S767

Copyright © American Heart Association, Inc. All rights reserved.
 VF treated with CPR/AED
 Ventricular Fibrillation which occurs in the out-of-hospital setting should be treated with CPR and an AED. Effective
CPR and early defibrillation are the key to positive outcomes for the unresponsive patient who is in ventricular
fibrillation.
 This ACLS scenario will usually involve one or two rescuers in an out-of-hospital setting. Ideal equipment would be
an AED and a pocket mask. Rapid assessment and treatment using the CAB sequence of BLS should be performed as
the first intervention.
 CPR
 CPR will be initiated if the patient does not have a palpable pulse or if it is undetermined if the patient has a pulse.
Delaying CPR reduces the chances of a successful resuscitation thus, it is better to give unnecessary CPR than to delay
CPR in questionable cases.
 CPR may be needed after successful defibrillation since spontaneous rhythms after defibrillation may not always
produced adequate perfusion for several minutes.
 The AED
 AED’s should be used when the following 3 clinical findings exist:
 Patient is not responsive
 Patient is not breathing
 Patient has no pulse
 Most AEDs or External Automated Defibrillators provide voice instructions from the point of turning on the machine.
The machine will perform the rhythm interpretation and will also instruct you when to shock the patient. It should
also instruct you to resume CPR when necessary.
 While using the AED, BLS should be maintained by giving high quality chest compressions and using basic airway
skills such as the head-tilt chin lift and mouth-to-barrier device resuscitation.
 Emergencies are treated in the following order: Check patient responsiveness, activate EMS, and get the AED, then
perform CABD’s of the BLS Primary Survey.
Commonly used ACLS drugs, such as epinephrine and
amiodarone, are then administered.
The ACLS personnel quickly search for possible reversible
causes of cardiac arrest (i.e. the H's and T's, heart attack).
Based on their diagnosis, more specific treatments are
given.
These treatments may be medical such as IV injection of
an antidote for drug overdose, or surgical such as
insertion of a chest tube for those with tension
pneumothoraces or hemothoraces.
 Consider amiodarone for ventricular fibrillation/pulseless ventricular tachycardia after 3 attempts at
defibrillation, as there is evidence it improves response in refractory VF / VT.(Note: as of the 2010
guidelines, amiodarone is preferred as the first-line antiarrythmic, moving lidocaine to a second-line
backup if amiodarone is unavailable
 For torsades de pointes, refractory VF in patients with digoxin toxicity or hypomagnesemia, give IV
magnesium sulfate 8 mmol (4mL of 50% solution)
 In the 2010 ACLS pulseless arrest algorithm, vasopressin may replace the first or second dose of
epinephrine. The inclusion of vasopressin is due to its theoretical benefit over epinephrine in cardiac
arrest. Vasopressin lacks intrinsic activity at cardiac beta-1 receptors, reducing myocardial and
cerebral oxygen demand compared to epinephrine in an oxygen-deprived state. Studies in humans
have failed to demonstrate a clinical benefit over epinephrine. In a systematic review and meta-
analysis (Aung and Htay, 2005), five key variables were reviewed and were found to have no
significant difference between epinephrine and vasopressin, regardless of the initial cardiac rhythm
which initiated the code (Ventricular Fibrillation/Tachycardia, Pulseless Electrical Activity, or
Asystole). Variables analyzed included failure of return of spontaneous circulation (ROSC) (risk ratio
[RR], 0.81; 95% confidence interval [CI], 0.58-1.12), death before hospital admission (RR, 0.72; 95%
CI, 0.38-1.39), death within 24 hours (RR, 0.74; 95% CI, 0.38-1.43), death before hospital discharge
(RR, 0.96; 95% CI, 0.87-1.05), or combination of number of deaths and neurologically impaired
survivors (RR, 1.00; 95% CI, 0.94-1.07)
 Patient’s with a PETCO2 levels less than 10 mm Hg during CPR will not achieve ROSC (return of
spontaneous circulation). It is recommended to switch the rescuer performing chest compressions,
to improve the PETCO2.
 Do not delay TCP for the patient with symptomatic bradycardia with
signs of poor perfusion. TCP rate should use 60/min as a starting rate
and adjust up or down based on the patient’s clinical response. The
dose for pacing should be set at 2mA (milliamperes) above the dose
that produces observed capture.
 TCP is contraindicated for the patient with hypothermia and is not a
recommended treatment for asystole.
 A carotid pulse should not be used for assessment of circulation as
TCP can create muscular movements that may feel like a carotid
pulse. Assess circulation using the femoral pulse.
 Identification of contributing factors for symptomatic bradycardia
should be considered throughout the ACLS protocal since reversing of
the cause will likely return the patient to a state of adequate
perfusion.
Notes on using the ACLS algorithm
Search for and correct potentially reversible causes of
arrest, brady/tachycardia.
Exercise caution before using epinephrine in arrests
associated with cocaine or other sympathomimetic drugs.
Epinephrine is not required until after the second DC
shock in standard ACLS management as DC shock in itself
releases significant quantities of epinephrine.
In PEA arrests associated with hyperkalemia,
hypocalcemia. or Ca2+channel blocking drug overdose,
give 10mL 10% calcium chloride (IV) (6.8 mmol/L)
ACLS Drugs
ACLS Drugs
Each of the ACLS Algorithms utilizes a number of
drugs which we will classify as “primary drugs”. The
“primary drugs” are the medications that are used
directly in an ACLS Algorithm.
During respiratory arrest, the ACLS provider
should avoid hyperventilation of the patient.
Hyperventilation is providing too many breaths
per minute or too large of a volume per breath
during ventilation.
Hyperventilation may lead to increased
intrathoracic pressure, decreased venous return to
the heart, diminished cardiac output, and
increased gastric inflation, all of which can
decrease the likelihood of positive outcomes.
For patients with a perfusing rhythm deliver 1
breath every 5 to 6 seconds.
 Opening Airway
The most common cause of airway obstruction in a
patient that is unresponsive is the loss of tone in the
throat muscles.
When loss of throat muscle tone occurs the tongue can
fall back and obstruct the airway.
This type of obstruction is easily prevented with a basic
airway opening technique called the head tilt-chin lift.
In the case that spinal injury is suspected, the jaw
thrust maneuver can be utilized.
This jaw thrust maneuver allows the BLS/ACLS
provider to maintain a stable cervical spine.