Advanced cardiac life support (ACLS) refers to emergency treatment protocols for cardiac arrest and other life-threatening medical issues. The current ACLS guidelines include algorithms, or flowcharts, to standardize treatment for conditions like ventricular fibrillation, pulseless ventricular tachycardia, asystole, and respiratory or opioid emergencies. Key interventions discussed include defibrillation, synchronized cardioversion, and use of medications like epinephrine, amiodarone, atropine, and dopamine for various cardiac dysrhythmias and arrest rhythms. High-quality CPR is emphasized as crucial to ACLS.

1. Advanced Cardiac Life Support
ACLS

2. Advanced Cardiac Life Support
Advanced cardiovascular life support (ACLS):
Refers to a set of clinical interventions for the urgent treatment
of cardiac arrest, stroke and other life-threatening medical
emergencies, as well as the knowledge and skills to deploy those
interventions.

3. 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,
making the algorithm easier to memorize.

4. Types of Algorithms
 Cardiac Arrest Algorithm:
PEA/A systole Algorithm
VF/Pulseless VT Algorithm
Bradycardia Algorithm
Tachycardia Algorithms
 Respiratory Arrest Algorithm
 Opioid Emergency Algorithm
 Suspected Stroke Algorithm
 Acute Coronary Syndromes Algorithm

5. Defibrillation
 Defibrillation involves using electrode paddles to direct an electric current through
the patient's heart.
 The current causes the myocardium to depolarize, which in turn encourages the
sinoatrial node to resume control of the heart's electrical activity.
 The electrode paddles delivering the current may be placed on the patient's chest or,
during cardiac surgery, directly on the myocardium.
 Because Ventricular Fibrillation leads to death if not corrected, the success of
defibrillation depends on early recognition and quick treatment of this arrhythmia.
 Defibrillators can be internal, external, transvenous, or implanted, depending on the
type of device used or needed. For the purpose of this lecture, only external
defibrillator will be discussed.

7. Synchronized Cardioversion
Cardioversion delivers an electric charge to the myocardium at the peak of the R wave.
This causes immediate depolarization allowing the sinoatrial node to resume control.
Synchronizing the electric charge with the R wave ensures that the current won't be delivered
on the vulnerable T wave and thus disrupt repolarization.
Uses:
a. Stable Paroxysmal Atrial tachycardia
b. Unstable Paroxysmal Supraventricular tachycardia
c. Atrial Fibrillation
d. Symptomatic Ventricular Tachycardia.

8. Cardiac Arrest:
A) Shockable rhythms
II. Ventricular Fibrillation
I. Pulseless V. Tachycardia

9. Cardiac Arrest:
B) Non-shockable rhythms
• A systole.
• PEA (Pulseless Electrical Activity)

10. Ventricular Fibrillation (VF)
&
Pulseless Ventricular Tachycardia (VT)
• Perform CPR until defibrillator Arrives
• VF/VT present on defibrillator
Defibrillate up to 3 times if needed for persistent VF/VT
200 J, 200 - 300 J, 360 J

11. • Continue CPR
• Intubate / IV Access
VF & Pulseless VT
Defibrillate 360 J,
30 - 60 sec after Rx
Epinephrine
1 mg/IV
2 mg/ETT
q 3 - 5 min
Administer Rx
Amiodarone
Defibrillate 360 J
within 30 - 60 sec

12. A systole Treatment Algorithm
• Continue CPR
• Intubate at once
• Obtain IV Access
• Confirm a systole in more than 1 lead
• Atropine 1 mg IV push
repeat q 3 - 5 min up to a total
of 0.03 - 0.04 mg/kg
• Epinephrine 1mg IV push,
repeat q 3 - 5 min
Consider possible causes
Hypoxia Pre-existing acidosis
Hyperkalaemia Drug Overdose
Hypokalaemia Hypothermia
Consider termination of efforts
Consider immediate
transcutaneous pacing (TCP)

13. Skills Checklist for (VF, pulseless VT, A systole)
• On arrival, you do a quick initial assessment while assessing
responsiveness, Pulse, and vital signs and immediately begin
compressions (another nurse).
• While compressions are occurring , apply pads and electrodes to the
patient to analyze the rhythm.
• In addition, oxygen be applied to the patient
• Ask about any complaints the patient may have had and find that
minutes ago he was complaining of chest pain, palpitations, and
dizziness.

14. • As you pause during compressions you analyze the
rhythm… the patient is in Ventricular Fibrillation !!!
• The CPR team runs into the room, you notify
him/her of the patient’s rhythm and
• ANALYZE.. CLEAR…SHOCK DELIVERED
• Resume CPR! Wait to reanalyze the rhythm after the
next round of CPR
• Give patient a dose of Epinephrine in addition to
another shock.
• Evaluate!!

15. High quality CPR is key
• Rate approx 100/min
• Compression depth at least
(5cm) in adults
• Allow complete chest recoil
after each compression
• Minimize interruptions
• Rotate every 2 minutes

17. Nursing Skills checklist:
•Follow algorithm
•Oxygen be applied to the patient
•Obtain Atropine from the crash cart and the
patient is bolused 0.5mg.
•Evaluate The patient’s HR and response (e.g still
remains somewhat confused and lethargic.

18. Tachycardia Algorithm
(Patient is not in Cardiac Arrest)
Assess ABC’s Assess vitals
Secure airway Review history
Administer O2 Perform physical exam
Start IV 12 lead ECG, chest x-ray
Attach monitor, pulse oximetry and B/P Cuff
If ventricular rate > 150 BPM
• Prepare for cardioversion
• May give Rx
• Immediate cardioversion is seldom
needed for heart rates < 150 BPM

19. Synchronized and unsynchronized cardioversion
Synchronized
Low energy shock
delivers shock w/ peak of QRS
Unsynchronized
High energy shock
delivers as soon as shock button
is pushed
Indications: pulseless VT/VF

20. Nursing Skills for stable tachycardia
• Provide oxygen per nasal cannula at 4 L/min.
• Continuously monitor ECG for rate, rhythm, and conduction.
• Assess vital signs and associated symptoms with changes in ECG.
• Report findings to physician.
• Explain the importance of rapidly reducing the heart rate.
• Explain the cardioversion procedure and encourage questions.
• Encourage verbalization of fears and concerns. Answer questions.
• Document pretreatment vital signs, level of consciousness, and
peripheral pulses.
• Assist with cardioversion as indicated.
• Assess LOC, cardiovascular, and respiratory status, and skin condition
following cardioversion. • Document procedure and

21. Dopamine Hydrochloride
(Intropin)
• Mechanism of action
− Increases myocardial
contractility and stroke
volume
• Indications
− Cardiogenic and
septic shock,
hypotension with low
cardiac output states
• Contraindications
− Hypovolemic shock,
Pheochromocytoma,
Tachydysrhythmias
• Adverse reactions
− Headache, anxiety,
dyspnea,
dysrhythmias
• Considerations
− Pregnancy safety:
Category C
− Effects are dose-
dependent

22. Amiodarone
(Cordarone, Pacerone)
• Mechanism of action
− Delays repolarization
and increases the
duration of action
potential
• Indications
− Ventricular fibrillation
• Contraindications
− Known
hypersensitivity to
amiodarone or iodine
− Cardiogenic shock
• Adverse reactions
− Dizziness, fatigue,
malaise
− Congestive heart
failure
• Considerations
− Pregnancy safety:
Category D
− Monitor patient
for hypotension.

23. Atropine Sulfate
• Mechanism of action
− Increases heart rate in
life-threatening
bradydysrhythmias
• Indications
− Hemodynamically
unstable bradycardia
• Contraindications
− Tachycardia,
hypersensitivity
• Adverse reactions
− Drowsiness,
confusion, headache,
tachycardia,
palpitations
• Considerations
− Pregnancy safety:
Category C
− Moderate doses may
cause pupillary
dilation.

24. Epinephrine
(Adrenalin)
• Mechanism of action
− Blocks histamine
receptors
• Indications
− Cardiac arrest,
symptomatic
bradycardia
• Contraindications
− Hypertension,
hypothermia,
pulmonary edema
• Adverse reactions
− Nervousness,
restlessness,
headache, tremor
• Considerations
− Pregnancy safety:
Category C
− May cause syncope in
asthmatic children

25. Thanks