ADVANCED CARDIOVASCULAR LIFE SUPPORT.pptx

ADVANCED CARDIOVASCULAR LIFE SUPPORT.

ADVANCED CARDIOVASCULAR LIFE SUPPORT.(ACLS)OBJECTIVES.Recognize and initiate early management or periarrest conditions that may result in cardiac aresst or complicate resuscitation outcome.Demonstrate proficiency in providing BLS care, including prioriting chest compression and integrating automated external defibrillator (AED) useRecognize and manage respiratory arrest.Recognize and manage cardiac arrest until termination of resuscitation or transfer of care, including immediate post-cardiac arrest care.Recognize and initiate early management of ACS , including approriate disposition.Recognize and initiate management of stroke , including appropriate disposition.Demonstrate effective communication as a member or leader of a resuscitation team and recognize the impact of team dynamics on overall team performance.ACLS SURVEYASSESSAIRWAY

-is the airway patent?-is an advanced airway indicated?-is proper placement of airway device confirmed?-is tube secured and placement reconfirmed frequently?ACTION AS APPROPRIATE- MAINTAIN AIRWAY PATENCY IN UNCONCIOUS PATIENTS by use the head tilt-chin lift, oropharyngeal airway (OPA), or nasopharyngeal airway (NPA)USE ADVANCED AIRWAY MANAGEMENT IF NEEDED (e.g, laryngeal mask airway, laryngeal tube, esopharyngeal-tracheal tube, endotracheal tube (ET tube)If use advanced airway devices:CONFIRM PROPER INTEGRATION OF CPR AND VENTILATION.CONFIRM PROPER PLACEMENT OF ADVANCED AIRWAY DEVICES.SECURE THE DEVICE TO PREVENT DISLODGE.MONITOR AIRWAY PLACEMENT WITH CONTINOUS QUQNTITATIVE WAVE FORM CAPNOGRAPHY.CONT.BREATHING

-are ventilation and oxygenation adequate?-are quantitative waveform capnography and oxyhemoglobin saturation monitored?

CIRCULATION

-are chest compression effective?-what is the cardiac rhytym?

-GIVE SUPPLEMENTARY OXYGEN WHEN INDICATED for cardiac arrest , administer 100% oxygen.For other, titrate oxygen administration to achieve > 94%-MONITOR THE ADEQUACY OF VENTILATION AND OXYGENATION by cliical criteriaAVOID EXCESSIVE VENTILATION.

MONITOR CPR QUALITYATTACH MONITOR/DEFIBRILLATOR OR ARRHYTHMIAS OR CARDIAC ARREST RHYTHM(e.g VF,pulseless VT,asystole, PEA)PROVIDE DEFIBRILLATION/CARDIOVERSIONOBTAIN IV/IO ACCESSGIVE APPROPRIATE DRUGS to manageRhythm and bp.Cont.-is defibrillator or cardioversion indicated? -has iv/io access been established?-is ROSC present?-Is the patient with a pulse unstable?-are medication needed for rhytym or bp?Does thepatient need fluid for resustitation?

GIVE IV/IO FLUID if needed.

Cont,DIFFERENTIAL DIAGNOSIS.-why did this patient develop symptoms or arrest?

SEARCH FOR, FIND AND TREAT REVERSIBLE CAUSES (ie, definitive care)

ACLS CASESThis case reviews appropriate assessment, intervention, and management option an unconscious, unresponsive adult patient in respiratory aresst. Respiration are completely absent or clearly inadequate to maintain effectively oxygenation and ventilation . A pulse is present (Do not confuse agonal gasp with adequate respirations).The BLS Survey and ACLS survey are used even though the patient is in respiratory aresst and not in cardiac aresst.

BLS SURVEY.ASESS

Check responsiveness

Activate the emergency response system/get AED.

CIRCULATION

ASSESSMENT TECHNIQUE AND ACTION.

-TAP AND SHOUT ARE YOU ALL RIGHT-CHECK FOR ABSENT OR ABNORMAL BREATHING (NO BREATHING OR ONLY GASPING) BY LOOKINGAT OR SCANNING THE CHEST FOR MOVEMENT (ABOUT 5 TO 10 SECOND )

-ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET AN AED IF ONE IS AVAILABLE OR SEND SOMEONE TO ACTIVATE THE EMERGENCY RESPONSE SYSTEM AND GET AN AED OR DEFIBRILLATOR.

-CHECK THE CAROTID PULSE FOR 5 TO 10 SECOND -If no pulse within 10 second, start CPR (30:2) beginning with chest compressions. -Compress the center of the chest (lower half of the sternum) hard and fast with at least 100 compression per minute at a depth of at least 2 inches. -allow complete chest recoil after each compression. -minimize interruptions in compression.(10 second or less)

Cont,DEFIBRILLATOR

-switch provider about every 2 minutes to avoid fatigue -Avoid excessive ventilationIf there is a pulse, start rescue breathing at 1 breath every 5 to 6 seconds (10 to 12 breaths per minute).check pulse about every 2 minute.

-IF NO PULSE, CHECK FOR A SHOCKABLE RYHTYM WITH AN AED/DEFIBRILLATOR AS SOON AS IT ARRIVES.PROVIDE SHOCKS AS INDICATEDFOLLOW EACH SHOCK IMMEDIATELY WITH CPR, BEGINNING WITH COMPRESSION.

ALGORITHM.