Acls 2018 pdf download

Initially provide rescue breaths using an ambu bag and a mask at full flow oxygen. Perform continued assessment of airway patency while giving breaths. Have the person doing chest compressions pause during the 2 rescue breaths. Confirm correct placement of the advanced airway device:. Look for condensation during exhalation.

Look for equal bilateral chest rise. Confirming equal bilateral breath sounds with auscultation. If incorrect placement:. Remove the airway device, ventilate the patient using the ambu bag for a short period of time, and then reattempt placement. If correct placement:.

Secure placement of the airway device. Continue to monitor:. Rescue breathing during CPR with an advanced airway:. Obtain IV or IO access. Initiate therapy of ACLS algorithm corresponding with the identified heart rhythm. Drug therapy, Electrical therapy, Pacing, etc. Differential Diagnosis. Differential Diagnosis Chart:. Oral Airway:. Assure the artificial airway is the appropriate size for the patient.

The airway should be easily inserted with a tongue blade. Avoid use in patients with an active gag reflex. Nasal Trumpet Airway:. Best practice is to lube before insertion. Careful not to cause trauma to nasal mucosa results in bleeding. This is reasonably tolerated by patients with an active gag reflex. When you are unable to open airway using head tilt-chin lift or jaw thrust maneuvers. If you have difficulty forming a seal with the face mask. If the patient requiring continued ventilatory support.

When the patient has a high risk for aspiration provide an ETT or Combitube. Endotracheal Tube ETT. Requires additional instrument for insertion laryngoscope, glidescope, fiberoptic. Laryngoscope blades average adult size : MAC 3 or 4, Miller 2 or 3. ETTs require mastery of technique for consistent appropriate placement.

Average size of ETT for orotracheal intubation for adults is 7. The ETT is placed into the trachea, having direct visualization of the vocal cords. Average depth of intubation:. Allows for positive pressure ventilation. Reduces risk of aspiration. Helps maintain placement of ETT. Confirm placement of ETT. Secure in place of ETT. Esophageal-Tracheal Combitube. Gently advance the combitube into the mouth midline along the base of the tongue. Assure tube rotation of the combitube is following the curvature of the pharynx.

The combitube provides ventilatory access irregardless of tracheal or esophageal intubation. Inflate the pharangeal cuff with ml of air. Prevents leak through the nose and mouth. Helps secure placement. Inflate the tracheal cuff with 15ml of air. Prevents ventilation of stomach. Reduces risk of aspiration of stomach content. If placement not confirmed through esophageal tube:. Attempt confirmation of tracheal intubation by ventilating through the tracheal tube. Once placement has been confirmed:.

Mark which tube should be used for ventilation. Secure tube in place. Both cuffs must be inflated to appropriately ventilate a patient in the case of esophageal intubation.

Visualization of the vocal cords is not required for insertion. When inserting the LMA have the laryngeal cuff deflated. Guide in the LMA cuff without folding back the tip, pressing it against the hard palate. Advance the LMA till the cuff lies in the pharynx. After placement, inflate the laryngeal cuff and check for an adequate seal by using positive pressure ventilation. Place pads and electrodes in correct position to assure an appropriate ECG reading.

Start at O mA and work energy level up until you have capture heart pulsation. The Pediatric Advanced Life Support PALS Certification teaches medical professionals to manage and respond to cardiopulmonary resuscitation of pediatric patients in emergency situations.

Resources Groups. ACLS algorithms are arguably the most crucial part of understanding the many advanced cardiac life saving procedures and are essential for passing the ACLS exam. Based on the latest AHA guidelines, our team of medical and education professionals worked to compose these algorithms to help you better comprehend the material and get you certified fast. Cardiac Arrest Circular Algorithm.

Suspected Stroke Algorithm. Post-Cardiac Arrest Care Algorithm. Acute Coronary Syndromes Algorithm. Bradycardia With A Pulse Algorithm. Tachycardia With A Pulse Algorithm. Lidocaine may replace amiodarone when amiodarone is not available.

First dose: Pulseless Electrical Activity and Asystole Pulseless electrical activity or PEA is a cardiac rhythm that does not create a palpable pulse is even though it should. After 2 min. Remember, chest compressions are a means of artificial circulation, which should deliver the epinephrine to the heart. Without chest compressions, epinephrine is not likely to be effective. Chest compressions should be continued while epinephrine is administered.

Rhythm checks every 2 min. Respiratory Arrest While cardiac arrest is more common in adults than respiratory arrest, there are times when patients will have a pulse but are not breathing or not breathing effectively e. Airway Management In ACLS, the term airway is used to refer both to the pathway between the lungs and the outside world and victim in the devices that help keep that airway open.

Choose the device that extends from the corner of the mouth to the earlobe Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device.

Choose the device that extends from the tip of the nose to the earlobe. Use the largest diameter device that will fit. Lubricate the airway with a water-soluble lubricant Insert the device slowly, straight into the face not toward the brain! It should feel snug; do not force the device. If it feels stuck, remove it and try the other nostril. Tips on Suctioning Adequate suctioning usually requires negative pressures of — 80 to mmHg.

Wallmounted suction can deliver this, but portable devices may not. When suctioning the oropharynx, do not insert the catheter too deeply. Extend the catheter to the maximum safe depth and suction as you withdraw. Therefore sterile technique should be used. Each suction attempt should be for no longer than 10 seconds. Monitor vital signs during suctioning and stop suctioning immediately if the patient experiences hypoxemia O2 sats 94 has a new arrhythmia, or becomes cyanotic.

You can detect spontaneous circulation by feeling a palpable pulse at the carotid artery. The patient is at risk for reentering cardiac arrest at any time. Therefore, the patient should be moved to an intensive care unit. If so, it should be placed. If not, there may be neurological compromise. Does the person have signs of myocardial infarction by ECG?

Move to ACS algorithm. Rapid Differential Diagnosis of Cardiac Arrest Many different disease processes and traumatic events can cause cardiac arrest, but in an emergency, it is important to be able to rapidly consider and eliminate or treat the most typical causes of cardiac arrest. Bradycardia Bradycardia Algorithm. Bradycardia is any heart rate less than 60 bpm. In practice, however, bradycardia is only a concern if it is unusual or abnormal for the patient or causing symptoms.

New cases of bradycardia should be evaluated, but most will not require specific treatment. Evaluation of bradycardia includes cardiac and blood oxygen monitoring and a 12 lead ECG if available. Unstable bradycardia i. Unstable bradycardia is first treated with intravenous atropine at a dose of 0. Additional doses can be given every 3 to 5 min.

Pulseless bradycardia is considered PEA. If atropine is unsuccessful in treating symptomatic, unstable bradycardia, consider transcutaneous pacing, dopamine or norepinephrine infusion, or transvenous pacing. An intensive or cardiologist may need to be consulted for these interventions and the patient may need to be moved to the intensive care unit. Tachycardia Atrial fibrillation is the most common arrhythmia. Tachycardia Algorithm Tachycardia is any heart rate greater than bpm.

In practice, however, tachycardia is usually only a concern if it is New cases of tachycardia should be evaluated with cardiac and blood oxygen monitoring and a 12 lead ECG if available. Consider beta-blocker or calcium channel blocker. Wide QRS tachycardia may require antiarrhythmic drugs. Acute Coronary Syndrome Acute coronary syndrome or ACS is a spectrum of signs and symptoms ranging from angina to myocardial infarction.

Cardiac chest pain any new chest discomfort should be evaluated promptly. This includes high degree of suspicion by individuals in the community, prompt rapid action by EMS personnel, assessment in the emergency department, and definitive treatment. People with symptoms of cardiac ischemia should be given oxygen, aspirin if not allergic , nitroglycerin, and possibly morphine. The patient should be assessed in the ED within 10 min. Draw and send labs e.

Give statin if not contraindicated. Obtain chest Xray. Unstable angina is new onset cardiac chest pain without ECG changes, angina that occurs at rest and lasts for more than 20 min.

People with unstable angina will not have elevated cardiac markers. His may include anti-platelet drug s , anticoagulation, a beta-blocker, an ACE inhibitor, a statin, and either PCI or a fibrinolytic. Patients with unstable angina are admitted and monitored for evidence of MI.

While in transit, the EMS team should try to determine the time at which the patient was last normal, which is considered the onset of symptoms. EMS administer oxygen via nasal cannula or face mask, obtain a fingerstick glucose measurement, and alert the stroke center.

Within 10 min. They should obtain vital signs and IV access, draw and send labs e. Within 25 min. Within 45 min. Within 60 min. If the patient with an ischemic stroke is not a candidate for fibrinolytic, administer aspirin if the patient is not allergic. If the patient is having a hemorrhagic stroke, neurosurgery should be consulted.

Time is Brain! Stroke Time Goals for Evaluation and Therapy In people who are candidates for fibrinolytics, the goal is to ad mister the agent within 3 hours of the onset of symptoms. Fibrinolytic Checklist for 3 to 4. Stroke Time Goals for Evaluation and Therapy…………………………………………………. Overview of Advanced Cardiovascular Life Support Advanced Cardiac Life Support, or ACLS, is a system of algorithms and best practice recommendations intended to provide the best outcome for patients in cardiopulmonary crisis.

Updates to ACLS in As we learn more about resuscitation science and medicine, physicians and researchers realize what works best and what works fastest in a critical, life-saving situation. If a feedback device is in place, depth can be adjusted to maximum of 2. In the community, call and send for an AED. Check the carotid pulse for no more than 10 seconds. If there is a shockable rhythm, pulseless ventricular tachycardia or ventricular fibrillation, provide a shock.

Select an airway that is the correct size for the patient Too big and it will damage the throat Too small and it will press the tongue into the airway. Choose the device that extends from the corner of the mouth to the earlobe. Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat. Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device.

Select an airway that is the correct size for the patient. Lubricate the airway with a water-soluble lubricant. Insert the device slowly, straight into the face not toward the brain! Adequate suctioning usually requires negative pressures of — 80 to mmHg. Rapid heart rate, narrow QRS complex,. Fluid resuscitation.

Decreased heart rate. Airway management, oxygen. Hydrogen Ion Acidosis. Fingerstick glucose testing. IV Dextrose. Flat T waves, pathological U wave.