The document outlines the objectives and systematic approaches for advance cardiac life support (ACLS), detailing the differences between heart attacks and cardiac arrests, risk factors, chain of survival, and assessment protocols. It provides guidelines for basic life support (BLS) steps, primary and secondary assessments, and highlights various arrhythmias and their management. The importance of early recognition, intervention, and prevention of cardiac events is emphasized, along with algorithms for post-cardiac arrest care.

1. Advance Cardiac Life Support

2. Objectives
• Heart Attach vs Cardiac Arrest.
• Risk factors that may result in cardiac arrest
• Chain of survival and systematic approach
• BLS Assessment and steps of BLS
• Primary and Secondary Assessment
• Early Recognition and Prevention of cardiac arrest
• Brady arrhythmias and its management.
• Tachyarrhythmia's and its management
• Cardiac arrest and post cardiac arrest algorithms

3. Heart Attack
• A heart attack results from a blocked artery impeding oxygen-rich
blood flow to the heart.
• Without prompt reopening, the affected heart tissue starts to die.
• Delay in treatment leads to increased damage to the heart muscle.
• Timely intervention is crucial to prevent irreversible harm and
minimize complications.

4. Cardiac Arrest
• Cardiac arrest occurs suddenly and often without warning.
• During cardiac arrest, the heart suddenly and unexpectedly stops beating
causing disruption of blood flow to the brain and other vital organs
• It happens when an electrical malfunction in the heart causes an irregular
heartbeat called arrhythmias.
• When this occurs, a person loses consciousness and has no pulse.
• Death occurs within minutes if the victim doesn't receive treatment.

5. Pulmonary
Electrolyte
Imbalance
Cardiac
Causes of Cardiopulmonary arrest

6. Risk Factors for Cardiac Arrest
• Most cardiac arrests occur when the heart’s electrical system malfunctions
• This malfunction causes an abnormal heart rhythm such as VT or VF.
• Some cardiac arrests are also caused by extreme slowing of the heart’s rate bradycardia
• Other causes of cardiac arrest include:
 Scarring of the heart tissue
 Thickened heart muscle (cardiomyopathy)
 Heart medications
 Electrical abnormalities
 Blood vessel abnormalities

7. Chain of Survival

8. Systematic Approach
• Systematic approach is used to assess and treat arrest and acutely ill or injured patients.
• For a patient in respiratory or cardiac arrest, high-performance teams aim to support and restore
effective oxygenation, ventilation, and circulation with return of intact neurologic function.
• An intermediate goal of resuscitation is ROSC.
• ACLS teams guide their actions by using the following systematic approaches:
• Initial assessment (visualization and scene safety)
• BLS Assessment
• Primary Assessment (A, B, C, D, and E)
• Secondary Assessment (SAMPLE, H’s and T’s)

9. BLS Assessment/ Steps of BLS
1. Check Scene safety
2. Check Response (Tap and Shout)
3. Activate Emergency Response System
4. Check Pulse and Breathing
5. IF No pulse: Begin CPR , start from Chest Compressions
6. After 5 cycles of CPR, check pulse again.
7. Attach AED as soon as possible

10. Use of an AED

11. High Quality Chest Compressions
• Position Victim ( Face up on Firm , flat surface)
• Compression to Ventilation Ratio ( 30:2)
• Compression Rate (100-120 Compressions per Minute)
• Compression depth ( 1/3th of total Chest Diameter, 5 cm)
• Chest Recoil (Re-Expand)
• Interruptions in chest compression ( CCF minimum 60%, Ideal >80%)

12. Primary Assessment
• A: Airway
• Is the patient’s airway patent?
• Is an advanced airway indicated?
• Have you confirmed proper placement of the airway device?
• B: Breathing
• Are ventilation and oxygenation adequate?
• Are quantitative waveform capnography and oxyhemoglobin saturation
monitored?

13. Primary Assessment
• C: Circulation
• What is the cardiac rhythm?
• Is defibrillation or cardioversion indicated?
• Is the patient with a pulse unstable?
• Are medications needed for rhythm or blood pressure?
• D: Disability
• Check for neurologic function.
• Quickly assess for responsiveness, levels of consciousness, and pupil dilation.
• E: Exposure
• Remove clothing to perform a physical examination.
• Look for obvious signs of trauma, bleeding, burns, unusual markings, or medical alert bracelets.

14. Secondary Assessment
• The Secondary Assessment involves the differential diagnosis, including a focused
medical history and searching for and treating underlying causes (H’s and T’s).
Consider using the memory aid SAMPLE:
• Signs and symptoms
• Allergies
• Medications (including the last dose taken)
• Past medical history (especially relating to the current illness)
• Last meal consumed
• Events

15. H’s and T’s
• Look for and treat the underlying cause by considering the H’s and T’s. The H’s and T’s
create a guide for possible diagnoses and interventions for your patient.
• The H’s and T’s are a memory aid for potential reversible causes of cardiac arrest and
emergency cardiopulmonary conditions.
• T’s
• Tension pneumothorax
• Tamponade (cardiac)
• Toxins
• Thrombosis (pulmonary)
• Thrombosis (coronary)
• H’s
• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
• Hypothermia

16. Preventing Arrest
• Rapid Response Team:
• Hospitals established RRT’s to provide early intervention
in patients whose conditions are deteriorating, to prevent
IHCA.
• RRT uses specific physiologic criteria to determine when
to act.

17. Red Flags for RRT
• Following list gives an example of such criteria for adult patients
• Airway compromise
• Respiratory rate less than 6/min or more than 30/min
• Heart rate less than 40/min or greater than 140/min
• SBP less than 90 mm Hg
• Symptomatic hypertension
• Unexpected decrease in the LOC
• Unexplained agitation
• Seizers
• Significant decrease in urine output
• Subjective concern about patient

18. Acute Coronary Syndrome
• Acute coronary syndromes (ACS), an umbrella term for situations in which
blood supplied to the heart muscle is suddenly blocked. It includes both heart
attach (MI) and unstable angina.
• The blockage is usually due to a blood clot and can be sudden and complete.
• If a clot forms due to a plaque rupture, a part of the clot may break away and
clog one of the coronary arteries causing ACS.
• Though less common, spasms in the coronary artery may also limit blood flow.
• 12 lead ECG is performed

19. TYPES
• STEMI: ST-segment elevation MI
• NSTEMI: Non-ST-segment elevation MI
Goal for STEMI patients is to
• Identify, assess and triage acute ischemic
discomfort
• Provide initial treatment
• Early reperfusion

20. Bradycardia
• A rhythm disorder with a heart rate of less than 60/min but for assessment and
management of a patient with symptomatic bradycardia, it is typically defined as having
heart rate less than 50/min. Types are:
• Sinus bradycardia
• First degree AV-Block
• Second degree AV-Block
• Mobitz type I AV-Block
• Mobitz type II AV-Block
• Third degree AV-Block

22. Sinus Bradycardia
• Sinus bradycardia is a sinus rhythm with a rate less than 60 per minute in an adult.

23. Heart Blocks
Second Degree Type-I or (Mobitz
Type-I:
• In this case PR interval is
progressively prolonging which
then fails to progress at last, so
there is lost QRS complex
First Degree Heart Block:
• In first degree heart block PR
Interval is prolonged, that is
more than 0.2 sec or more than
one big square

24. Heart Blocks
Mobitz Type-II:
▪ In this case the PR interval is fix,
but sinus impulse fails to pass
through AV node and thus produce
2:1, 3:1, 4:1 blocks
Third degree Heart Block:
• In 3rd
degree block both atria and
ventricles have their own focal
impulse production and there will be
no association between P wave and
QRS complex

25. Adult
Bradycardia
Algorithm

26. Tachycardia: Stable and Unstable
• Tachycardia in adults refers to a heart rate of more than 100 beats per minute. Sinus
tachycardia usually does not require treatment and returns to normal with treating the
underline cause.
• Tachyarrhythmia's are abnormal heart rhythms with a ventricular rate of 100 or more
beats per minute.
• These rhythms are classified as either narrow or wide-complex tachycardia with further
subdivision into regular or irregular rhythm.
• Most of tachyarrhythmia's are symptomatic at the rate of 150 or more per minute

27. Tachyarrhythmia
Sinus tachycardia:
• When heart rate is more than
100/min, and every P wave is
followed by QRS complex
SVT:
• Supraventricular tachycardia
is abnormal fast heart
rhythm, P wave is difficult to
identify but rhythm is regular

28. Arrhythmias
Atrial Flutter:
• When heart rate is 250-
350. There will a saw
tooth but rate of QRS
complex will be normal
Atrial Fibrillation:
• The rate is usually fast
where P wave can’t be
differentiated and
rhythm is irregular

29. Arrhythmias
Ventricular Tachycardia:
• In VT there is twisting ECG
rhythm having no P wave and
QRS complex is wide
• Ventricular Fibrillation:
• In VF there will be irregular
rhythm, P wave and QRS
complex can not be differentiated.
• VF may coarse or fine

30. Adult
Tachycardia
Algorithm

31. Adult Cardiac
Arrest Algorithm

32. Post Cardiac
Arrest Care
Algorithm

33. References
American Heart Association. (2020). Advanced cardiovascular life support:
Provider Manual.