Basic life support

BASIC LIFE SUPPORT - CPR
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Basic Life SupportBasic Life Support –– CPR Visual AidsCPR Visual Aids
Introduction to BLSIntroduction to BLS -- CPRCPR
THE PHILIPPINE NATIONAL RED CROSSTHE PHILIPPINE NATIONAL RED CROSS
SAFETY SERVICESSAFETY SERVICES
1. BASIC Life Support (BLS)1. BASIC Life Support (BLS)
An emergency procedure that consists of recognizing respiratoryAn emergency procedure that consists of recognizing respiratory or cardiac arrestor cardiac arrest
or both and the proper application of CPR to maintain life untilor both and the proper application of CPR to maintain life until a victim recovers ora victim recovers or
advanced life support is available.advanced life support is available.
2. Advanced Cardiac Life Support (ACLS)2. Advanced Cardiac Life Support (ACLS)
3. Prolonged Life Support (PLS)3. Prolonged Life Support (PLS)
The use of special equipment to maintain breathing and circulatiThe use of special equipment to maintain breathing and circulation for the victimon for the victim
of a cardiac emergency.of a cardiac emergency.
For post resuscitative and long term resuscitation.For post resuscitative and long term resuscitation.
Kinds of Life SupportKinds of Life Support
LIFE SUPPORTLIFE SUPPORT
1. The First Link: EARLY ACCESS1. The First Link: EARLY ACCESS
2. The Second Link: EARLY CPR2. The Second Link: EARLY CPR
3. The Third Link: EARLY DEFIBRILLATION3. The Third Link: EARLY DEFIBRILLATION
It is the event initiated after the patientIt is the event initiated after the patient’’s collapse until the arrival of Emergencys collapse until the arrival of Emergency
Medical Services personnel prepared to provide care.Medical Services personnel prepared to provide care.
It is most effective when started immediately after the victimIt is most effective when started immediately after the victim’’s collapse. Thes collapse. The
probability of survival approximately doubles when it is initiatprobability of survival approximately doubles when it is initiated before the arrivaled before the arrival
of EMS.of EMS.
4. The Fourth Link: EARLY ACLS4. The Fourth Link: EARLY ACLS
It is most likely to improve survival. It is the key interventioIt is most likely to improve survival. It is the key intervention to increase the chancesn to increase the chances
of survival of patients withof survival of patients with ““outout--ofof--hospitalhospital”” cardiac arrest.cardiac arrest.
If provided by highly trained personnel like paramedics, provisiIf provided by highly trained personnel like paramedics, provision of advancedon of advanced
care outside the hospital would be possible.care outside the hospital would be possible.
Four LinksFour Links
CHAIN OF SURVIVALCHAIN OF SURVIVAL
1. Medial (I)1. Medial (I)
2. Prone Position (C)2. Prone Position (C)
3. Inferior (F)3. Inferior (F)
4. Proximal (K)4. Proximal (K)
6. Distal (L)6. Distal (L)
7. Posterior (H)7. Posterior (H)
8. Lateral recumbent position (D)8. Lateral recumbent position (D)
9. Superior (E)9. Superior (E)
10. Lateral (J)10. Lateral (J)
12. Anterior (G)12. Anterior (G)
13. Supine position (B)13. Supine position (B)
15. Anatomical position (A)15. Anatomical position (A)
Anatomical TermsAnatomical Terms
16. Deep (N)16. Deep (N)
5. Internal (O)5. Internal (O)
14. Superficial (M)14. Superficial (M)
11. External (Q)11. External (Q)
HUMAN BODYHUMAN BODY

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Body SystemsBody Systems
1. The Respiratory System1. The Respiratory System
It supply oxygen to the body, as well as removesIt supply oxygen to the body, as well as removes
carbon dioxide from the body. The passage of air intocarbon dioxide from the body. The passage of air into
and out of the lungs is called respiration. Breathing inand out of the lungs is called respiration. Breathing in
is called inspiration or inhaling. Breathing out is calledis called inspiration or inhaling. Breathing out is called
expiration or exhaling.expiration or exhaling.
HUMAN BODY contHUMAN BODY cont……
Body SystemsBody Systems
2.2. The Circulatory SystemThe Circulatory System
It delivers oxygen and nutrients to the bodyIt delivers oxygen and nutrients to the body’’s tissuess tissues
and removes waste products. It consists of the heart,and removes waste products. It consists of the heart,
blood vessels, and blood.blood vessels, and blood.
It is composed of the brain, spinal cord and nerves. It has twoIt is composed of the brain, spinal cord and nerves. It has two major functionsmajor functions ––
communication and control. It lets a person be aware of and reaccommunication and control. It lets a person be aware of and react to thet to the
environment. It coordinates the bodyenvironment. It coordinates the body’’s responses to stimuli and keeps body systemss responses to stimuli and keeps body systems
working together.working together.
3. The Nervous System3. The Nervous System
Body System cont...Body System cont...
Breathing and CirculationBreathing and Circulation
•• Air that enters the lungs contains:Air that enters the lungs contains:
–– 21% O221% O2
–– trace of CO2trace of CO2
•• Air exhaled from the lungs contains:Air exhaled from the lungs contains:
–– 16% O216% O2
–– 4% CO24% CO2
•• Clinical deathClinical death (0(0 -- 4 min.4 min. -- brain damage notbrain damage not
likely, 4likely, 4 -- 6 min.6 min. -- damage probable).damage probable).
•• Biological deathBiological death (6(6 -- 10 min.10 min. -- brain damagebrain damage
probable; over 10 min.probable; over 10 min. -- brain damage is certain).brain damage is certain).
Body System cont...Body System cont...
Body Substance IsolationBody Substance Isolation
Are precautions taken to isolate or prevent risk of exposure froAre precautions taken to isolate or prevent risk of exposure from any other type ofm any other type of
bodily substance.bodily substance.
Basic Precautions and PracticesBasic Precautions and Practices
1. Personal Hygiene1. Personal Hygiene 2. Protective Equipment2. Protective Equipment 3. Equipment Cleaning3. Equipment Cleaning
& Disinfecting& Disinfecting
PRECAUTIONS TO PREVENTPRECAUTIONS TO PREVENT
DISEASE TRANSMISSIONDISEASE TRANSMISSION
Risk Factors for Cardiovascular DiseasesRisk Factors for Cardiovascular Diseases
1. Risk factors that cannot be changed (Non1. Risk factors that cannot be changed (Non--modifiable) :modifiable) :
•• HeredityHeredity
•• AgeAge
•• GenderGender
2. Risk factors that can be changed (Modifiable) :2. Risk factors that can be changed (Modifiable) :
•• Cigarette smoking.Cigarette smoking.
•• Elevated cholesterol and triglyceride levels.Elevated cholesterol and triglyceride levels.
•• HypertensionHypertension
•• ObesityObesity
•• StressStress
•• Lack of exercises.Lack of exercises.
•• Diabetes mellitus.Diabetes mellitus.
CARDIOVASCULAR DISEASESCARDIOVASCULAR DISEASES

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HEART ATTACK ( Myocardial Infarction)HEART ATTACK ( Myocardial Infarction)
It occurs when the oxygen supply to the heart muscle (myocardiumIt occurs when the oxygen supply to the heart muscle (myocardium) is cut) is cut--off for a prolongedoff for a prolonged
period of time. This cutperiod of time. This cut--off results from a reduced blood supply due to severe narrowingoff results from a reduced blood supply due to severe narrowing oror
complete blockage of the diseased artery. The result is death (icomplete blockage of the diseased artery. The result is death (infarction) of the affected partnfarction) of the affected part
of the heart.of the heart.
CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont……
First Aid Management of Heart AttackFirst Aid Management of Heart Attack
1. Recognized the signals of heart attack and take action.1. Recognized the signals of heart attack and take action.
2. Have patient stop what he or she is doing and sit or lie him/2. Have patient stop what he or she is doing and sit or lie him/her down in a comfortableher down in a comfortable
position. Do not let the patient move around.position. Do not let the patient move around.
3. Have someone call the physician or ambulance for help.3. Have someone call the physician or ambulance for help.
4. If patient is under medical care, assist him/her in taking hi4. If patient is under medical care, assist him/her in taking his/her prescribed medicine/s.s/her prescribed medicine/s.
CARDIOVASCULAR DISEASES contCARDIOVASCULAR DISEASES cont……
Guidelines in Giving Emergency CareGuidelines in Giving Emergency Care
After completing this module, participants will be able toAfter completing this module, participants will be able to--
•• Demonstrate how to do a primary survey.Demonstrate how to do a primary survey.
1. Explain the need of preparation to a proper emergency care.1. Explain the need of preparation to a proper emergency care.
2. Describe the four emergency action principles2. Describe the four emergency action principles
3. Enumerate the golden rules in giving emergency care.3. Enumerate the golden rules in giving emergency care.
TR 2TR 2--11
KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES:
SKILL OBJECTIVES:SKILL OBJECTIVES:
1. Plan of Action1. Plan of Action
2. Gathering of Needed Materials2. Gathering of Needed Materials
3. Initial Response:3. Initial Response:
Emergency plans should be established based on anticipated needsEmergency plans should be established based on anticipated needs andand
available resources.available resources.
The emergency response begins with the preparation of equipmentThe emergency response begins with the preparation of equipment and personneland personnel
before any emergency occurs.before any emergency occurs.
•• Ask for HELP.Ask for HELP.
•• InterveneIntervene
•• Do not further harm.Do not further harm.
TR 2TR 2--22
4. Instruction to Helper/s4. Instruction to Helper/s
Proper information and instruction to a helper/s would provide oProper information and instruction to a helper/s would provide organized first aidrganized first aid
care.care.
GETTING STARTEDGETTING STARTED
Elements of the Survey the SceneElements of the Survey the Scene
•• Scene safety.Scene safety.
•• Mechanism of injury or nature of illness.Mechanism of injury or nature of illness.
•• Determine the number of patients andDetermine the number of patients and
additional resources.additional resources.
TR 2TR 2--33
1. Survey the Scene1. Survey the Scene
Once you recognized that an emergency has occurred and decide toOnce you recognized that an emergency has occurred and decide to act, youact, you
must make sure the scene of the emergency is safe for you, the vmust make sure the scene of the emergency is safe for you, the victim/s, andictim/s, and
any bystander/s.any bystander/s.
EMERGENCY ACTION PRINCIPLESEMERGENCY ACTION PRINCIPLES
TR 2TR 2--44
Phone First and Phone FastPhone First and Phone Fast
Both trained and untrained bystanders shouldBoth trained and untrained bystanders should
be instructed to Activate Medical Assistance asbe instructed to Activate Medical Assistance as
soon as they have determined that an adultsoon as they have determined that an adult
victim requires emergency carevictim requires emergency care ““Phone FirstPhone First””..
While for infant and children aWhile for infant and children a ““Phone FastPhone Fast””
approach is recommended.approach is recommended.
2. Activate Medical Assistance and Transfer Facility2. Activate Medical Assistance and Transfer Facility
In some emergency, you will have enough time to call for specifiIn some emergency, you will have enough time to call for specific medical advicec medical advice
before administering first aid. But in some situations, you willbefore administering first aid. But in some situations, you will need to attend toneed to attend to
the victim first.the victim first.
EMERGENCY ACTION PRINCIPLES contEMERGENCY ACTION PRINCIPLES cont……

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TR 2TR 2--55
1. Check for Consciousness1. Check for Consciousness
3. Do a Primary Survey of the Victim3. Do a Primary Survey of the Victim
In every emergency situation, you must first find out if there aIn every emergency situation, you must first find out if there are conditions thatre conditions that
are an immediate threat to the victimare an immediate threat to the victim’’s life.s life.
2. Check for Airway2. Check for Airway
3. Check for Breathing3. Check for Breathing
4. Check for Circulation4. Check for Circulation
TR 2TR 2--66
1. Interview the victim.1. Interview the victim.
4. Do a Secondary Survey of the Victim4. Do a Secondary Survey of the Victim
It is a systematic method of gathering additional information abIt is a systematic method of gathering additional information aboutout
injuries or conditions that may need care.injuries or conditions that may need care.
2. Check vital signs.2. Check vital signs.
3. Perform head3. Perform head--toto--toe examination.toe examination.
Respiratory Arrest & Rescue BreathingRespiratory Arrest & Rescue Breathing
•• Demonstrate how to provide rescue breathing for an adult, child,Demonstrate how to provide rescue breathing for an adult, child, & infant& infant
who shows signs of circulation but not breathing or inadequate.who shows signs of circulation but not breathing or inadequate.
1. Describe what is respiratory arrest.1. Describe what is respiratory arrest.
3. Describe the ways in ventilating the lungs.3. Describe the ways in ventilating the lungs.
TR 3TR 3--11
2. Identify the causes of respiratory arrest.2. Identify the causes of respiratory arrest.
After completing this sessions, participants will be able toAfter completing this sessions, participants will be able to--
Is the condition in which breathing stops or inadequate.Is the condition in which breathing stops or inadequate.
Is a technique of breathing air into a person lungs to supply hiIs a technique of breathing air into a person lungs to supply him or her with them or her with the
oxygen needed to survive.oxygen needed to survive.
RESPIRATORY ARRESTRESPIRATORY ARREST
RESCUE BREATHINGRESCUE BREATHING
1. Mouth1. Mouth--toto--
MouthMouth
StomaStoma
3. Mouth3. Mouth--toto--MouthMouth
and Noseand Nose
2. Mouth2. Mouth--
toto--NoseNose
WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS
Face ShieldFace Shield
MaskMask
7. Bag Mask7. Bag Mask
DeviceDevice
WAYS TO VENTILATE THE LUNGSWAYS TO VENTILATE THE LUNGS

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Face mask
Bag mask
Foreign Airway Obstruction ManagementForeign Airway Obstruction Management
•• Demonstrate how to provide Heimlich maneuver to an adult, childDemonstrate how to provide Heimlich maneuver to an adult, child & infant& infant
who have obstructed airway.who have obstructed airway.
1. Identify the causes, types, and classification of obstruction1. Identify the causes, types, and classification of obstruction..
2. Describe Heimlich maneuver.2. Describe Heimlich maneuver.
TR 4TR 4--11
After completing this session, participants will be able toAfter completing this session, participants will be able to--
It happens when the tongue drops back andIt happens when the tongue drops back and
obstruct the throat. Other causes are acuteobstruct the throat. Other causes are acute
asthma, croup, diphtheria, swelling, and coughasthma, croup, diphtheria, swelling, and cough
(whooping).(whooping).
Foreign Body Airway Obstruction ManagementForeign Body Airway Obstruction Management
1. Anatomical Obstruction1. Anatomical Obstruction
2. Mechanical Obstruction2. Mechanical Obstruction
When foreign objects lodge in the pharynx orWhen foreign objects lodge in the pharynx or
airways; fluids accumulate in the back of theairways; fluids accumulate in the back of the
throat.throat.
TWO TYPES OF OBSTRUCTIONTWO TYPES OF OBSTRUCTION
1. Partial obstruction with good air exchange.1. Partial obstruction with good air exchange.
2. Partial obstruction with poor air exchange.2. Partial obstruction with poor air exchange.
3. Complete or total obstruction.3. Complete or total obstruction.
The victim is responsive and can cough forcefully, although freqThe victim is responsive and can cough forcefully, although frequently thereuently there
is wheezing between coughs.is wheezing between coughs.
The victim has a weak, ineffective cough, highThe victim has a weak, ineffective cough, high--pitched noise while inhaling,pitched noise while inhaling,
increased respiratory difficulty, and possibly cyanosis.increased respiratory difficulty, and possibly cyanosis.
The victim is unable to speak, breathe, or cough and may clutchThe victim is unable to speak, breathe, or cough and may clutch the neck withthe neck with
the thumb and fingers. Movement of air is absent.the thumb and fingers. Movement of air is absent.
CLASSIFICATION OF OBSTRUCTIONCLASSIFICATION OF OBSTRUCTION
Heimlich maneuver or abdominal thrusts is recommended for relievHeimlich maneuver or abdominal thrusts is recommended for relieving foreign bodying foreign body
airway obstruction.airway obstruction.
HEIMLICH MANEUVERHEIMLICH MANEUVER
Cardiac Arrest & Cardiopulmonary ResuscitationCardiac Arrest & Cardiopulmonary Resuscitation
•• Demonstrate how to provide Cardiopulmonary Resuscitation to an aDemonstrate how to provide Cardiopulmonary Resuscitation to an adult,dult,
child & infant who have cardiac arrest.child & infant who have cardiac arrest.
1. Describe cardiac arrest.1. Describe cardiac arrest.
2. Enumerate the three conditions of cardiac arrest.2. Enumerate the three conditions of cardiac arrest.
TR 5TR 5--11
3. Enumerate the criteria for not starting CPR and when to STOP3. Enumerate the criteria for not starting CPR and when to STOP CPR.CPR.
After completing the class, participants will be able toAfter completing the class, participants will be able to--

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Is the condition in which circulation ceases andIs the condition in which circulation ceases and
vital organs are deprived of oxygen.vital organs are deprived of oxygen.
TR 5TR 5--22
CARDIAC ARRESTCARDIAC ARREST
1.1. Cardio Vascular CollapseCardio Vascular Collapse
2.2. Ventricular FibrillationVentricular Fibrillation
3.3. Cardiac Stand StillCardiac Stand Still
THREE CONDITONS OF CARDIAC ARRESTTHREE CONDITONS OF CARDIAC ARREST
This is a combination of chest compressionThis is a combination of chest compression
and rescue breathing. This must be combinedand rescue breathing. This must be combined
for effective resuscitation of the victim offor effective resuscitation of the victim of
cardiac arrest.cardiac arrest.
CARDIOPULMONARYCARDIOPULMONARY
RESUSCITATION (CPR)RESUSCITATION (CPR)
CoughCough -- CPRCPR
Compression OnlyCompression Only -- CPRCPR
TR 5TR 5--33
1. SPONTANEOUS1. SPONTANEOUS signs of circulation are restored.signs of circulation are restored.
2. TURNED2. TURNED over to medical services or properly trained and authorizedover to medical services or properly trained and authorized
personnel.personnel.
3. OPERATOR3. OPERATOR is already exhausted and cannot continue CPR.is already exhausted and cannot continue CPR.
4. PHYSICIAN4. PHYSICIAN assumes responsibility (declares death, take over, etc.).assumes responsibility (declares death, take over, etc.).
WHEN TO S.T.O.P. CPRWHEN TO S.T.O.P. CPR
TR 5TR 5--44
Survey the Scene.Survey the Scene.
““The Scene is SafeThe Scene is Safe””..
““Activate Medical Assistance & Transfer FacilityActivate Medical Assistance & Transfer Facility””..
Check Responsiveness,Check Responsiveness,
““HeyHey MamMam/Sir are you OK? Victim Unresponsive/Sir are you OK? Victim Unresponsive””..
Open Airway (HeadOpen Airway (Head--TiltTilt--Chin Lift) Check AirwayChin Lift) Check Airway
Check Breathing (Look, Listen & Feel) for 5 seconds.Check Breathing (Look, Listen & Feel) for 5 seconds.
““Victim is BreathlessVictim is Breathless””..
Give 2 Initial Ventilatory Maneuver (2 breaths).Give 2 Initial Ventilatory Maneuver (2 breaths).
Check for Signs of Circulation for at least 10 seconds.Check for Signs of Circulation for at least 10 seconds.
““Victim has no signs of Circulation IVictim has no signs of Circulation I’’ll perform CPRll perform CPR””..
““Victim has inadequate/no breathing but with Signs of CirculationVictim has inadequate/no breathing but with Signs of Circulation II’’ll performll perform
Rescue BreathingRescue Breathing””..
SEQUENCE IN PERFORMING CPR & RBSEQUENCE IN PERFORMING CPR & RB
ACLS APPROACHACLS APPROACH
OBJECTIVESOBJECTIVES
1.1. Describe the 8 steps of the ACLSDescribe the 8 steps of the ACLS
approachapproach
2. For each step of the ACLS Approach2. For each step of the ACLS Approach
describe 2 acts of assessment anddescribe 2 acts of assessment and
managementmanagement
3. Describe how you can apply this3. Describe how you can apply this
approach to almost all cardiovascularapproach to almost all cardiovascular
emergenciesemergencies

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8 Things to Recall in an Emergency8 Things to Recall in an Emergency
Airway: Is the airway open?
Breathing: Is the victim moving air
adequately?
Circulation: Is there a pulse? If
not, is CPR being performed
effectively?
Defibrillation: if no pulse, has
someone checked whether
rhythm is VF?
Is a defibrillator on the way?
Is it ready to deliver a shock?
Airway: open the airway
Breathing: provide positive-
pressure Ventilations
Circulation: give chest
compressions
Defibrllation: shock VF/pulseless
VT
Primary ABCD Survey
(ACLS Questions to Ask)
Primary Survey: ABCD
(Basic Steps)
Airway:
•provide advanced airway
management
•tracheal intubation,
laryngeal mask
airway, Combitube
Secondary Survey: ABCD
(Basic Steps)
Airway:
• Is advanced
airway needed now?
•If yes, intubate victim with laryngeal
mask airway, Combitube, or tracheal
tube
Secondary Survey:
ABCD Survey
(Basic Steps)
Breathing: confirm tube placement
primarily (physical examination),
secondarily (check end-tidal CO2 and
esophageal placement), check for
adequate oxygenation and ventilation
(Basic Steps)
Breathing: Primary confirmation
(physical examination) of proper
placement of airway device
Breathing: Secondary confirmation
(end-tidal CO2 detectors, esophageal
detector devices) of proper device
placement
Breathing: Adequate oxygenation and
ventilation? Is it possible to provide
continuous/intermittent monitoring of
CO2 and oxygen levels
Breathing: Is tube secured to prevent
dislodgment? Is commercial tube
holder being used or tape-and-tie
techniques? Is proper tube placement
reconfirmed frequently
Survey(Basic Steps)
Circulation: obtain IV access,
determine rhythm, give medications
appropriate for rhythm and vital signs
(Basic Steps)
Circulation: What was the initial
cardiac rhythm? What is current
cardiac rhythm?
Circulation:has someone obtained
access to the venous circulation? Can
fluids and medication now be given?
Have all medications and
interventions been providedas
indicated for this rhythm and overall
clinical condition?
Survey(Basic Steps)
Differential Diagnosis:
search for, find, and treat reversible
cause
(Basic Steps)
Differential Diagnosis:
Now… what is wrong with
this patient? Why did
adequate respirations and
heartbeat stop? Why did the
patient go into an
arrest?What do we see,
hear, smell, know or quickly
learn that might help us
identify a reversible cause
of the arrest?
Survey(Basic Steps)

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Initial ResponsesInitial Responses
The initial responses also include:The initial responses also include:
•• Assess responsivenessAssess responsiveness
•• Call fastCall fast
•• Appropriately position the patientAppropriately position the patient
•• Appropriately position yourself as theAppropriately position yourself as the
rescuerrescuer
Assessment processAssessment process
•• Person CollapsesPerson Collapses
•• Possible Cardiac ArrestPossible Cardiac Arrest
•• Assess ResponsivenessAssess Responsiveness
Assess ResponsivenessAssess Responsiveness
•• Always assume that the victim is in cardiacAlways assume that the victim is in cardiac
respiratory arrest or both unless provenrespiratory arrest or both unless proven
otherwiseotherwise
•• Establish unresponsiveness with theEstablish unresponsiveness with the
traditionaltraditional ““shake and shoutshake and shout”” step:tapstep:tap andand
gently shake the victim and shoutgently shake the victim and shout ““AreAre
you OKyou OK””
call for helpcall for help
•• Advance care, in the form of electricalAdvance care, in the form of electrical
defibrillation, advanced airwaydefibrillation, advanced airway
management, and IV medications, mustmanagement, and IV medications, must
be on the way to the patient as soon asbe on the way to the patient as soon as
possiblepossible
Q? to Assess ResponsivenessQ? to Assess Responsiveness
•• Did the victim fall from a height?Did the victim fall from a height?
•• Or collapse with great force?Or collapse with great force?
•• Or dive head first?Or dive head first?
•• Or experience a motor vehicle crash?Or experience a motor vehicle crash?
•• Activate emergency responseActivate emergency response
•• Call for defibrillatorCall for defibrillator
Begin Primary ABCD SurveyBegin Primary ABCD Survey
AA Assess breathing (open airway, look,Assess breathing (open airway, look,
listen, and feel)listen, and feel)

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A: Assess the AirwayA: Assess the Airway
•• Begin with an assessment of the airway,Begin with an assessment of the airway,
first opening the airway and checking forfirst opening the airway and checking for
spontaneous breathingspontaneous breathing
•• The basic techniques for opening theThe basic techniques for opening the
airway are the head tiltairway are the head tilt--chin maneuverchin maneuver
and the jawand the jaw--thrust maneuverthrust maneuver
Head TiltHead Tilt--chin Liftchin Lift
This maneuver pulls the base of the tongueThis maneuver pulls the base of the tongue
away from the back of the throat, thusaway from the back of the throat, thus
maintaining a more open airway:maintaining a more open airway:
•• Open the mouth, inspect the upper airwayOpen the mouth, inspect the upper airway
for foreign objects, vomitus, or blood. If afor foreign objects, vomitus, or blood. If a
foreign object is present, remove it withforeign object is present, remove it with
your fingers covered with a piece of cloth.your fingers covered with a piece of cloth.
Head TiltHead Tilt--chin Liftchin Lift
If there is no possibility of a cervical spineIf there is no possibility of a cervical spine
Injury, remove material obstructing theInjury, remove material obstructing the
airway by turning the patient on his or herairway by turning the patient on his or her
sideside
•• Place the edge of one hand on the victimPlace the edge of one hand on the victim’’ss
forehead. Begin to gently tilt the headforehead. Begin to gently tilt the head
back. At the same time place 2 fingers ofback. At the same time place 2 fingers of
the other hand under the chin and liftthe other hand under the chin and lift
upward, tilting the head backupward, tilting the head back
JawJaw--Thrust ManeuverThrust Maneuver
The jaw thrust maintains the neutralThe jaw thrust maintains the neutral
positionofpositionof the cervical spine whilethe cervical spine while
resuscitative efforts continue. Use the jawresuscitative efforts continue. Use the jaw
thrust when you encounter patients with thethrust when you encounter patients with the
combination of possible cervical spinecombination of possible cervical spine
injuries and respiratory compromise orinjuries and respiratory compromise or
victims of trauma.victims of trauma.
The Advanced ACLS SkillsThe Advanced ACLS Skills
OverviewOverview
2 Basic ACLS Skills2 Basic ACLS Skills
1.1. CPRCPR
2.2. AED (Automated External Defibrillators)AED (Automated External Defibrillators)

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Advanced ACLS SkillsAdvanced ACLS Skills
1.1. Care of the airwayCare of the airway
2.2. Recognition of rhythmRecognition of rhythm
3.3. Electrical therapy I (defibrillation)Electrical therapy I (defibrillation)
4.4. Electrical therapy II (Electrical therapy II (cardioversioncardioversion))
5.5. Electrical therapy III (Electrical therapy III (transcutaneoustranscutaneous
pacing)pacing)
6.6. IVIV accesacces to circulationto circulation
7.7. Selection of appropriate resuscitationSelection of appropriate resuscitation
medicationmedication
Secondary (Advanced) ABCD SurveySecondary (Advanced) ABCD Survey
A.A. Secondary ASecondary A
–– establish an airway withestablish an airway with (1) tracheal(1) tracheal
intubationintubation
B. Secondary BB. Secondary B
-- provide ventilation (breathing) with properlyprovide ventilation (breathing) with properly
placed tracheal tubes and airway ductsplaced tracheal tubes and airway ducts
C. Secondary CC. Secondary C
–– Restore circulation with:Restore circulation with:
(2) Defibrillation(2) Defibrillation
(3)(3) CardioversionCardioversion
(4)(4) TranscutaneousTranscutaneous pacingpacing
(5) Recognition of the rhythm(5) Recognition of the rhythm
(6) Initiation of IV access(6) Initiation of IV access
(7) IV medications(7) IV medications
D. Secondary DD. Secondary D
–– Perform a differential diagnosisPerform a differential diagnosis
ACLS Skill 1:ACLS Skill 1:
Take care of the airwayTake care of the airway
1.1. Provide supplemental oxygenProvide supplemental oxygen
–– without respiratory distresswithout respiratory distress
•• 22 lpmlpm thru nasalthru nasal cannulacannula
–– mild respiratory distressmild respiratory distress
•• 5 to 65 to 6 lpmlpm thru nasalthru nasal cannulacannula
–– severe respiratory distress, acute congestivesevere respiratory distress, acute congestive
heart failure, cardiac arrestheart failure, cardiac arrest
•• Use a system that provides a high inspiredUse a system that provides a high inspired
oxygen concentration (preferably 100%)oxygen concentration (preferably 100%)
–– COPD, who may be dependent on hypoxiaCOPD, who may be dependent on hypoxia
drvendrven ventilationventilation
•• Low dose supplemental oxygen via a 24%Low dose supplemental oxygen via a 24% VenturiVenturi
maskmask
–– Most serious casesMost serious cases
•• Move quickly to advanced airway devices,Move quickly to advanced airway devices,
intubationintubation and 100% oxygenand 100% oxygen

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•• Devices used to administer supplementalDevices used to administer supplemental
oxygenoxygen
–– Oxygen supplyOxygen supply
–– NasalNasal cannulacannula
•• Starting deviceStarting device
•• Up to 44% oxygenUp to 44% oxygen
–– 1 L/min: 24%1 L/min: 24% 2 L/min: 28%2 L/min: 28%
–– Face maskFace mask
–– Up to 60% oxygenUp to 60% oxygen
–– 6 to 10 L/min6 to 10 L/min
–– Face mask with oxygen reservoirFace mask with oxygen reservoir
••up to 90up to 90 –– 100 % oxygen100 % oxygen
–– 6 L/min: 60%6 L/min: 60%
–– 7 L/min: 70%7 L/min: 70%
–– 8 L/min: 80%8 L/min: 80%
–– 9 L/min: 90%9 L/min: 90%
–– 10 L/min: almost 100%10 L/min: almost 100%
••for use on patients who:for use on patients who:
–– Seriously ill, responsive, spontaneouslySeriously ill, responsive, spontaneously
breathing, require high oxygen concentrationbreathing, require high oxygen concentration
–– May avoid trachealMay avoid tracheal intubationintubation if acuteif acute
interventions produce a rapid clinical effectinterventions produce a rapid clinical effect
–– Have relative indications for trachealHave relative indications for tracheal intubationintubation
but maintain a gag reflexbut maintain a gag reflex
–– Have relative indications forHave relative indications for intubationintubation butbut
have clenched teeth or other physical barriershave clenched teeth or other physical barriers
to immediateto immediate intubationintubation
2. Open the airway: recognize airway2. Open the airway: recognize airway
obstructionobstruction
–– Head and Jaw position:Head and Jaw position:
•• Loss of tone in throat muscles (most common)Loss of tone in throat muscles (most common)
–– Basic Opening TechniquesBasic Opening Techniques
•• Head tiltHead tilt
•• Jaw ThrustJaw Thrust
3. Maintain the open airway using3. Maintain the open airway using
airway adjunctsairway adjuncts
–– Assume that obstruction is produced by eitherAssume that obstruction is produced by either
the tongue or relaxed throat musclesthe tongue or relaxed throat muscles
–– Insert anInsert an oropharyngealoropharyngeal or nasopharyngealor nasopharyngeal
airwayairway
•• Manage foreignManage foreign--body airway obstructionbody airway obstruction
with the BLS technique ofwith the BLS technique of
subdiaphragmaticsubdiaphragmatic abdominal thrusts andabdominal thrusts and
the advanced technique of directthe advanced technique of direct
laryngoscopylaryngoscopy
•• Use forceps to grasp and remove theUse forceps to grasp and remove the
foreign bodyforeign body

12
OROPHARYNGEAL AIRWAYSOROPHARYNGEAL AIRWAYS
–– Devices that hold the tongue away from theDevices that hold the tongue away from the
posterior wall of the pharynxposterior wall of the pharynx
–– Useful in spontaneous breathers who areUseful in spontaneous breathers who are
unconscious or semiconscious with no coughunconscious or semiconscious with no cough
or gag reflexor gag reflex
–– At risk of occluding the airway via tongue andAt risk of occluding the airway via tongue and
phanryngealphanryngeal relaxationrelaxation
–– Keep the airway open during bagKeep the airway open during bag--maskmask
ventilationventilation
–– Helps in mouth suction and prevents occlusionHelps in mouth suction and prevents occlusion
of tracheal tubeof tracheal tube
Technique:Technique:
•• Clear the mouth and pharynxClear the mouth and pharynx
•• Place the airway backwardsPlace the airway backwards
•• Rotate the airway 180Rotate the airway 180˚˚ as it passes throughas it passes through
the oral cavity and approaches thethe oral cavity and approaches the prosteriorprosterior
pharynxpharynx
•• Make sure that you have clear breath soundsMake sure that you have clear breath sounds
upon placement of airwayupon placement of airway
•• Maintain proper head positionMaintain proper head position
Hazards:Hazards:
•• LongLong oropharyngealoropharyngeal airway may press theairway may press the
epiglottis against the entrance of theepiglottis against the entrance of the
larynxlarynx
•• May push the tongueMay push the tongue posteriorlyposteriorly
•• Prevent trauma: make sure tongue andPrevent trauma: make sure tongue and
lips are note between the airway andlips are note between the airway and
teethteeth
•• Should only be used in unconscious orShould only be used in unconscious or
semiconscious without cough or gag reflexsemiconscious without cough or gag reflex
NASOPHARYNGEAL AIRWAYSNASOPHARYNGEAL AIRWAYS
-- UncuffedUncuffed tubes made of soft rubber or plastictubes made of soft rubber or plastic
-- For intoxicated or semiconscious who cannotFor intoxicated or semiconscious who cannot
tolerate antolerate an oropharyngealoropharyngeal airwayairway
-- Indicated when the insertion orIndicated when the insertion or oropharyngealoropharyngeal
airway is technically difficult or impossibleairway is technically difficult or impossible
•• TechniqueTechnique
•• Proper sized airway is lubricated properlyProper sized airway is lubricated properly
•• Inserted close to the midline along the floor ofInserted close to the midline along the floor of
the nostrilthe nostril
•• Continue inserting into the posterior pharynx,Continue inserting into the posterior pharynx,
behind the tonguebehind the tongue
•• Slight rotation may facilitate insertion if withSlight rotation may facilitate insertion if with
resistanceresistance
•• HazardsHazards
•• May enter theMay enter the esophagusesophagus
•• May precipitateMay precipitate laryngospasmlaryngospasm and vomitingand vomiting
•• May injure nasal mucosa and cause bleedingMay injure nasal mucosa and cause bleeding
•• Maintain proper head positionMaintain proper head position

13
PRECAUTIONSPRECAUTIONS
–– Always check spontaneous respirationsAlways check spontaneous respirations
immediately after insertion of airwayimmediately after insertion of airway
–– If respirations are absent, start artificialIf respirations are absent, start artificial
positive pressure ventilationpositive pressure ventilation
–– If adjuncts are unavailable, use mouthIf adjuncts are unavailable, use mouth--toto--
mouth resuscitationmouth resuscitation
4. Ventilate the patient4. Ventilate the patient
•• MouthMouth--toto--Mouth and MouthMouth and Mouth--toto--NoseNose
VentilationVentilation
–– Default methodDefault method
–– Because a major mistake has been madeBecause a major mistake has been made
–– Limitations:Limitations:
•• RescuerRescuer’’s vital capacitys vital capacity
•• Reduced concentration of exhaled airReduced concentration of exhaled air
–– Professional rescuers should always have aProfessional rescuers should always have a
barrier devicebarrier device
•• Mouth to pocket face maskMouth to pocket face mask
–– Must be transparentMust be transparent
–– Tight fit in faceTight fit in face
–– Has an oxygen inletHas an oxygen inlet
–– Available in different sizesAvailable in different sizes
–– AdvantageAdvantage
•• Effective ventilation and oxygenationEffective ventilation and oxygenation
•• EliminateEliminate’’ss direct contactdirect contact
•• Possible supplemental oxygenPossible supplemental oxygen
•• Eliminates exposure to victimEliminates exposure to victim’’s exhaled gasess exhaled gases
•• Easy to teach and learnEasy to teach and learn
•• Superior to bag mask techniqueSuperior to bag mask technique
•• SelfSelf--inflating Ventilation Bags: Attached toinflating Ventilation Bags: Attached to
Valves, Masks and Other Airway AdjunctsValves, Masks and Other Airway Adjuncts
-- Mainstay of emergency ventilationMainstay of emergency ventilation
-- Universal connectorsUniversal connectors
-- One way valves to protect rescuerOne way valves to protect rescuer
-- Oxygen portsOxygen ports
-- Medication portsMedication ports
-- Suction portsSuction ports
-- Ports for quantitative sampling of end tidalPorts for quantitative sampling of end tidal
CO2CO2
•• BagBag--Valve Masks: Adequate Seal andValve Masks: Adequate Seal and
VolumeVolume
–– Insert OP airwayInsert OP airway
–– Recommended tidal volume: 10 to 15Recommended tidal volume: 10 to 15 mLmL/kg/kg
–– 80 kg man: needs 800 to 120080 kg man: needs 800 to 1200 mLmL perper
squeeze of bagsqueeze of bag
–– Most bags: 1600Most bags: 1600 mLmL
–– 1 handed squeeze: 50% of bag (8001 handed squeeze: 50% of bag (800 mLmL))

14
•• Good seal cannot be achieved when thereGood seal cannot be achieved when there
is only one rescuer using the bagis only one rescuer using the bag--maskmask
devicedevice
•• Seal problems do not occur when the bagSeal problems do not occur when the bag
is attached to the end of anis attached to the end of an EndotrachealEndotracheal
tube or LMAtube or LMA
•• Use a three second ventilation cycleUse a three second ventilation cycle
•• Recommended features of bag masksRecommended features of bag masks
–– Self refilling bag that is easily cleaned andSelf refilling bag that is easily cleaned and
sterilizedsterilized
–– Connections for delivery of high concentrationConnections for delivery of high concentration
of oxygenof oxygen
–– Capability to perform satisfactorily in allCapability to perform satisfactorily in all
conditionsconditions
–– Availability in different sizesAvailability in different sizes
–– True nonTrue non rebreathingrebreathing valvevalve
5. Provide adequate ventilation5. Provide adequate ventilation
•• TrachealTracheal intubationintubation
–– Provides definitive airway managementProvides definitive airway management
–– Should be provided by trained personnel asShould be provided by trained personnel as
soon as possiblesoon as possible
•• TrachealTracheal intubationintubation::
–– Keeps the airway patentKeeps the airway patent
–– Ensures delivery of highEnsures delivery of high concentratiojnconcentratiojn of O2of O2
–– Ensures delivery of selected tidal volumeEnsures delivery of selected tidal volume
–– Isolates and protects the airway fromIsolates and protects the airway from
aspirationaspiration
–– Permits effective suctioning of tracheaPermits effective suctioning of trachea
–– Provides route for administration of otherProvides route for administration of other
medicationsmedications
–– Indications:Indications:
••Cardiac arrest with ongoing chestCardiac arrest with ongoing chest
compressionscompressions
••Inability of a conscious patient inInability of a conscious patient in
respiratory compromise to breatherespiratory compromise to breathe
adequatelyadequately
••Inability of the patient to protect the airwayInability of the patient to protect the airway
(coma,(coma, areflexiaareflexia, cardiac arrest), cardiac arrest)
••Inability of the rescuer to ventilate theInability of the rescuer to ventilate the
unresponsive patient with conventionalunresponsive patient with conventional
methodsmethods
6. Provide definitive airway control6. Provide definitive airway control
•• OverviewOverview
-- Prepare forPrepare for intubationintubation with necessarywith necessary
equipmentequipment
-- Ask second rescuer to applyAsk second rescuer to apply cricoidcricoid pressurepressure
-- Prepare trachealPrepare tracheal intubationintubation
-- Inflate cuffInflate cuff
-- Attach ventilation bagAttach ventilation bag
-- Confirm placementConfirm placement

15
•• CricoidCricoid PressurePressure ManeuverManeuver
–– Why?Why?
••protects against regurgitation of gastricprotects against regurgitation of gastric
contentscontents
••Helps ensure tube placementHelps ensure tube placement
–– TechniqueTechnique
••Find the prominent thyroid cartilageFind the prominent thyroid cartilage
••Find the soft depression below the thyroidFind the soft depression below the thyroid
cartilagecartilage
••Find the hard prominence just below thatFind the hard prominence just below that
••Apply firm pressure while pinching theApply firm pressure while pinching the
thumb and index finger towards thethumb and index finger towards the
victimvictim’’s back and somewhat towards thes back and somewhat towards the
headhead
••Release pressure only when proper tubeRelease pressure only when proper tube
placement is confirmed and the cuff isplacement is confirmed and the cuff is
inflatedinflated
7. Provide primary and secondary7. Provide primary and secondary
confirmation of tracheal tubeconfirmation of tracheal tube
placementplacement
PrimaryPrimary
-- As the bag is squeezed, listen over theAs the bag is squeezed, listen over the
epigastriumepigastrium and observe the chest wall forand observe the chest wall for
movement.movement.
-- If you hear stomach gurgling and no chestIf you hear stomach gurgling and no chest
rise, you haverise, you have intubatedintubated thethe esophagusesophagus
-- Stop ventilation and remove tubeStop ventilation and remove tube
–– ReattemptReattempt intubationintubation afterafter reoxygenatingreoxygenating thethe
victimvictim
–– If the chest wall rises and no stomachIf the chest wall rises and no stomach
gurgling listen to the lung fields withgurgling listen to the lung fields with 5 point5 point
auscultationauscultation and document in medical recordand document in medical record
––Left and right anteriorLeft and right anterior
–– left and rightleft and right mmiidaxillarydaxillary
–– over the stomachover the stomach
–– If there is any doubt, useIf there is any doubt, use laryngscopelaryngscope toto
directly visualize (tube passing thru vocal cords)directly visualize (tube passing thru vocal cords)
–– Secure the tubeSecure the tube
–– Insert OP airwayInsert OP airway
–– Look for moisture condensation inside the tubeLook for moisture condensation inside the tube
SecondarySecondary
-- Use of variety of electronic and mechanicalUse of variety of electronic and mechanical
devicesdevices
How to Ventilate With a Properly PlacedHow to Ventilate With a Properly Placed
Tracheal TubeTracheal Tube
–– tidal volume of 10tidal volume of 10--1515 mLmL/kg/kg
–– 1 breath every 5 seconds1 breath every 5 seconds
–– 2 seconds for each bag ventilation2 seconds for each bag ventilation
–– Ventilate with 100% oxygenVentilate with 100% oxygen
–– when O2 saturation measurements arewhen O2 saturation measurements are
available respond accordingly when there is aavailable respond accordingly when there is a
fall in the O2 saturationfall in the O2 saturation

16
•• Unprotected airwayUnprotected airway
–– sets of 15 compressions at 100 per minutesets of 15 compressions at 100 per minute
–– 2 ventilations at 2 seconds per ventilation2 ventilations at 2 seconds per ventilation
•• Protected airwayProtected airway
–– Continuous compression at 100 per minuteContinuous compression at 100 per minute
–– Asynchronous with 1 ventilation at 2 secondsAsynchronous with 1 ventilation at 2 seconds
per ventilation every 5 secondsper ventilation every 5 seconds
•• Obtain a chest xObtain a chest x--ray as soon as possible toray as soon as possible to
confirm position of tube within tracheaconfirm position of tube within trachea
•• Never use a chestNever use a chest xrayxray to detectto detect
inadvertentinadvertent esophagealesophageal insertion.insertion.
ComplicationsComplications
Insertion of Tube IntoInsertion of Tube Into EsophagusEsophagus
•• Accidental insertion of tube intoAccidental insertion of tube into esophagusesophagus willwill
result in no oxygenation or ventilationresult in no oxygenation or ventilation
Tube Trauma and Adverse EffectsTube Trauma and Adverse Effects
•• Lacerated lips or tongueLacerated lips or tongue
•• Chipped teethChipped teeth
•• Lacerated pharynx or tracheaLacerated pharynx or trachea
•• Injury to the vocal cordsInjury to the vocal cords
•• PharyngealPharyngeal--esophagealesophageal perforationperforation
•• Vomiting and aspiration of the gastric contents intoVomiting and aspiration of the gastric contents into
the lower airwaythe lower airway
•• Release of high levels of epinephrine andRelease of high levels of epinephrine and
norepinephinenorepinephine
Insertion of Tracheal Tube Into 1 LungInsertion of Tracheal Tube Into 1 Lung
•• Hypoxemia due toHypoxemia due to underinflationunderinflation of 1 lungof 1 lung
Airway Control on Trauma PatientsAirway Control on Trauma Patients
•• Assume that the patient with multiple trauma,Assume that the patient with multiple trauma,
head injury or facial trauma has cervical spinehead injury or facial trauma has cervical spine
injuryinjury
Steps to follow in known or suspectedSteps to follow in known or suspected
cervical spine traumacervical spine trauma
–– Perform chin lift or Jaw thrust without head tiltPerform chin lift or Jaw thrust without head tilt
–– Stabilize head in neutral positionStabilize head in neutral position
–– OrotrachealOrotracheal intubationintubation in a patient with facialin a patient with facial
fractures and fractures at the base of the skull,fractures and fractures at the base of the skull,
another should provide spinal immobilizationanother should provide spinal immobilization
–– Suction upper airwaySuction upper airway
–– ConsiderConsider cricothyrotomycricothyrotomy oror tracheostomytracheostomy
–– Use paralytic drugs in patients who cannot be inUse paralytic drugs in patients who cannot be in
patients who cannot bepatients who cannot be intubatedintubated with thewith the
above techniquesabove techniques
Additional Techniques for InvasiveAdditional Techniques for Invasive
Airway Control and VentilationAirway Control and Ventilation
CricotyrotomyCricotyrotomy
–– Allows rapid entrance into the airwayAllows rapid entrance into the airway
–– CricothyroidCricothyroid membrane is opened with amembrane is opened with a
scalpel and a tube is insertedscalpel and a tube is inserted

17
TracheostomyTracheostomy
–– Surgical opening of the trachea and insertionSurgical opening of the trachea and insertion
ofof tracheostomytracheostomy tubetube
–– Performed under controlled conditions in thePerformed under controlled conditions in the
OROR
–– Should be performed after the airway hasShould be performed after the airway has
been secured by a tracheal tube orbeen secured by a tracheal tube or
cricotyrotomycricotyrotomy
–– Not appropriate for urgent situations (airwayNot appropriate for urgent situations (airway
obstruction or cardiac arrest)obstruction or cardiac arrest)
Recognize the rhythmRecognize the rhythm
•• Ventricular fibrillationVentricular fibrillation
•• PulselessPulseless ventricular tachycardiaventricular tachycardia
•• PulselessPulseless electrical activityelectrical activity
•• asystoleasystole
1.1. Cardiac Arrest (lethal) RhythmsCardiac Arrest (lethal) Rhythms
A.A. ShockableShockable rhythmsrhythms
a)a) VFVF
b)b) pulselesspulseless VTVT
B.B. NonshockableNonshockable rhythmsrhythms
a)a) AsystoleAsystole
b)b) PulselessPulseless electrical activityelectrical activity
-- Includes rhythms that produce electrical activity onIncludes rhythms that produce electrical activity on
the monitor but no palpable pulsethe monitor but no palpable pulse
-- Electromechanical dissociation,Electromechanical dissociation, bradyasystolicbradyasystolic
rhythms,rhythms, pulselessidioventricularpulselessidioventricular rhythmsrhythms
2. Non Cardiac Arrest (2. Non Cardiac Arrest (nonlethalnonlethal) Rhythms) Rhythms
A.A. Rhythm too slow ( < 60Rhythm too slow ( < 60 bpmbpm))
B.B. Rhythm too fast ( > 120Rhythm too fast ( > 120 bpmbpm))
DefibrillateDefibrillate
1.1. Turn on defibrillatorTurn on defibrillator
2.2. Select energy level at 200 J forSelect energy level at 200 J for
monophasicmonophasic defibrillatorsdefibrillators
3.3. SetSet ““lead selectlead select”” switch onswitch on ““paddlespaddles””
4.4. Apple gel or conductor padsApple gel or conductor pads
5.5. Position paddlesPosition paddles
6.6. Visually check the monitor display andVisually check the monitor display and
assess rhythmassess rhythm
7.7. ““ChargingCharging fibrillatorfibrillator –– Stand Clear!Stand Clear!””
8.8. Press charge button on apex paddle orPress charge button on apex paddle or
defibrillator controlsdefibrillator controls
9.9. When fully charged state firmly:When fully charged state firmly:
a)a) ““II’’m going to shock on three. One, Im going to shock on three. One, I’’mm
clear.clear.””
b)b) ““Two, youTwo, you’’re clear.re clear.””
c)c) ““Three, everybodyThree, everybody’’s clear.s clear.””
10.10.Apply 25lb of pressure on both paddlesApply 25lb of pressure on both paddles
11.11.Press the 2 paddlePress the 2 paddle ““dischargedischarge”” buttonbutton
simultaneouslysimultaneously

18
12.12.Check the monitorCheck the monitor
13.13. Shock at 200 to 300 J, then at 360 JShock at 200 to 300 J, then at 360 J
ACLS SkillACLS Skill
4:4:
CardiovertCardiovert
TranscutaneousTranscutaneous PacingPacing
–– Delivers pacing impulses to the heart throughDelivers pacing impulses to the heart through
the skin via adhesive electrodesthe skin via adhesive electrodes
–– Use ofUse of transcutaneoustranscutaneous pacing forpacing for asystoleasystole andand
pulselesspulseless electrical activity has beenelectrical activity has been
disappointingdisappointing
Gain IV Access to theGain IV Access to the
CirculationCirculation
•• Administer drugs and fluidsAdminister drugs and fluids
•• Obtain venous blood for laboratoryObtain venous blood for laboratory
determinationsdeterminations
•• Insert catheters into the central circulationInsert catheters into the central circulation
•• PeripheralPeripheral venipuncturevenipuncture
–– Arm vein (Arm vein (antecubitalantecubital or hand)or hand)
–– External jugular veinExternal jugular vein
•• CentralCentral venipuncturevenipuncture
–– Internal jugular veinInternal jugular vein
–– SubclavianSubclavian veinvein
–– Common femoral veinCommon femoral vein

19
•• Peripheral linePeripheral line
–– Procedure of choiceProcedure of choice
–– Peripheral sites are compressiblePeripheral sites are compressible
–– May collapse during low flow statesMay collapse during low flow states
•• Central lineCentral line
–– Predictable locationPredictable location
–– Allows for the use of large bore cathetersAllows for the use of large bore catheters
–– Permits infusion of concentrated solutionsPermits infusion of concentrated solutions
(greater flow)(greater flow)
–– Damage to surrounding structuresDamage to surrounding structures
•• General PrinciplesGeneral Principles
–– Speed is essentialSpeed is essential
–– Strict aseptic technique may be impossibleStrict aseptic technique may be impossible
–– After patient is stabilizedAfter patient is stabilized cannulacannula should beshould be
removed and replacedremoved and replaced
–– During cardiac arrest follow all administeredDuring cardiac arrest follow all administered
drugs by bolus administration of at least 20mldrugs by bolus administration of at least 20ml
of IV salineof IV saline
Provide AppropriateProvide Appropriate
Resuscitation MedicationsResuscitation Medications
•• Medications are used to meet the followingMedications are used to meet the following
major objectivesmajor objectives
–– Correct hypoxemiaCorrect hypoxemia
–– Restore spontaneous circulation at an adequate bloodRestore spontaneous circulation at an adequate blood
pressurepressure
–– Promote optimal cardiac functionPromote optimal cardiac function
–– Prevent or suppress significantPrevent or suppress significant arrythmiasarrythmias
–– Relieve painRelieve pain
–– Correct electrolyte abnormalities, adjust acidosis,Correct electrolyte abnormalities, adjust acidosis,
counteract effects of excessive amounts of prescribedcounteract effects of excessive amounts of prescribed
medications or illegitimate agentsmedications or illegitimate agents
–– Treat congestive heart failureTreat congestive heart failure
SummarySummary
1.1. Airway managementAirway management
2.2. Rhythm recognitionRhythm recognition
3.3. DefibrillationDefibrillation
4.4. CardioversionCardioversion
5.5. TranscutaneousTranscutaneous pacingpacing
6.6. Direct circulation access though intravenousDirect circulation access though intravenous
catheterscatheters
7.7. Administration of appropriate resuscitationAdministration of appropriate resuscitation
medicationsmedications

Basic life support

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