Advanced cardiac life support, or advanced cardiovascular life support, often referred to by its acronym, "ACLS", refers to a set of clinical algorithms for the urgent treatment of cardiac arrest, stroke, myocardial infarction (also known as a heart attack), and other life-threatening cardiovascular emergencies.

1. ADVANCED CARDIAC
LIFE SUPPORT
BY
HIMANSHU RATHORE
M.SC. NURSING
1ST YEAR

2. ADVANCED LIFE SUPPORT IN PERSPECTIVE
Chain of survival:
 Early access to emergency services(102).
 Early Basic life support(by hand only).
 Early defibrillation.
 Early advanced life support.

3. INTRODUCTION
• According to recent statistics sudden cardiac arrest is rapidly becoming the
leading cause of death.
• Once the heart ceases to function, a healthy human brain may survive without
oxygen for up to 4 minutes without suffering any permanent damage.
• Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes

4. • The goal of advanced cardiovascular life support is to achieve the best possible
outcome for individual who are experiencing a life- threating event.
• These ACLS protocols have been developed through research, patient case
student, clinical studies and opinion of experts in the field.
• All ACLS providers are perfumed capable of performing BLS correctly.

5. • While ACLS providers should always be mindful of timeliness.
• It is important to provide the intervention that most appropriately fits the needs
of the individual.
• Proper utilization of ACLS requires rapid and accurate assessment of an
individual’s condition.

6. CHAIN OF SURVIVAL

7. WHAT IS BLS ??
• Basic Life Support (BLS) refers to the care healthcare providers and public safety
professionals provide to patients who are experiencing respiratory arrest, cardiac
arrest or airway obstruction.
• BLS includes psychomotor skills for performing high-quality cardiopulmonary
resuscitation (CPR), using an automated external defibrillator (AED) and relieving
an obstructed airway for patients of all ages

8. COMPONENTS OF BLS
• Ensure safety
• Check for response
• Activate EMS
• Chest compressions
• Check airway and ventilate
• Defibrillate

9. CHARACTERISTICS OF GOOD COMPRESSION
• “Push hard push fast”. Push at a rate of 100-120 min.
• Compression depth- at least 2 inches(5cm) not more than 2.5 inches
• Release completely to allow the chest to fully recoil.
• A compression-ventilation ratio of 30:2 .
• Do not bounce your hands up and down on the victim's chest.
• Never use the palm of your hand, use the heel of your hand.

10. When 2 or more rescuers available,
• Switch the compressor about every 2 minutes (or after 5 cycles of compressions
and ventilations at a ratio of 30:2).
• Accomplish this switch in ≤5 seconds.

11. Advanced airway and 2 rescuers
• Continuous chest compressions at a rate of 100-120 /min without pauses for
ventilation.
• The rescuer delivering ventilation provides 8 to 10 breaths per minute.
• Rescuers should continue CPR until an AED arrives

12. INITIAL ASSESSMENT
• Determining whether an individual is conscious or unconscious can be done very
quickly. If you notice someone in distress, lying down in a public place, or
possibly injured, call out to EMS.
• If the individual is unconscious, then start with the BLS survey and move on to the
ACLS survey. If they are conscious, then start with the ACLS survey.

13. ACLS
• Understanding normal cardiac anatomy and physiology is an important
component of performing ACLS.
• The heart is hollow muscle comprised of four chambers surrounded by thick wall
of tissue(septum). The atria are two upper chambers and ventricles are two lower
chambers.
• The left ands right valves of heart work together to pump the blood throughout
the body.

14. THE ACLS SURVEY
AIRWAY :-
Maintain airway in unconscious patient
Consider advanced airway
Monitor advanced airway if placed with quantitative waveform capnography.

15. BREATHING
• Give 100% oxygen.
• Assess effective ventilation with quantitative waveform capnography.
• Do not over-ventilate.

16. CIRCULATION
• Evaluate rhythm and pulse.
• Defibrillation/Cardioversion
• Obtain IV/IO access
• Give rhythm- specific medication
• Give IV/IO fluids if needed

17. DIFFERENTIAL DIAGNOSIS
• Identify and treat reversible causes.
• Cardiac rhythm and patient history are the keys to differential diagnosis.
• Assess when to shock versus medicate.

18. DEFIBRILLATION
• Defibrillation is a process in which an electronic device sends an electric shock to
the heart to stop an extremely rapid, irregular heartbeat, and restore the normal
heart rhythm.
• Defibrillation is a common treatment for life threatening cardiac dysrhythmias,
ventricular fibrillation, and pulse less ventricular tachycardia.

20. HISTORY OF DEFIBRILLATION
• Defibrillation was invented in____ by Prevost and Batelli, two Italian physiologists.
They discovered that electric shocks could convert ventricular fibrillation to sinus
rhythm in dogs.The first case of a human life saved by defibrillation was reported
by Beck in 1947 .

21. TYPES OF DEFIBRILLATION
a) Internal defibrillator
• Electrodes placed directly to the heart e.g..-Pacemaker
b) External defibrillator
• Electrodes placed directly on the heart e.g..-AED

22. TYPES OF DEFIBRILLATOR ELECTRODES:-
a) Spoon shaped electrode
• Applied directly to the heart
b) Paddle type electrode
• Applied against the chest wall
c) Pad type electrode
• Applied directly on chest wall

24. NEED OF DEFIBRILLATION
• Ventricular fibrillation can be converted into a more efficient rhythm by applying
a high energy shock to the heart.
• This sudden surge across the heart causes all muscle fibres to contract
simultaneously.
• The instrument for administering the shock is called a DEFIBRILLATOR.
• Possibly, the fibres may then respond to normal physiological pace making

25. PLACEMENT OF ELECTRODES
• One electrode is placed over the left precordium (the
lower part of the chest, in front of the heart). The other
electrode is placed on the back, behind the heart in the
region between the scapula. This placement is preferred
because it is best for non-invasive pacing

27. PURPOSE OF DEFIBRILLATION
• Defibrillation is performed to correct life threatening fibrillations of the heart,
which could result in cardiac arrest. It should be performed immediately after
identifying that the patient is experiencing a cardiac emergency, has no pulse,
and is unresponsive

28. PRINCIPLE OF DEFIBRILLATION
• Energy storage capacitor is charged at relatively slow rate .
• Energy stored in capacitor is then delivered at a relatively rapid rate to chest of
the patient.
• Simple arrangement involve the discharge of capacitor energy through the
patient’s own resistance.

29. MECHANISM
• Fibrillations cause the heart to stop pumping blood, leading to brain damage.
• Defibrillators deliver a brief electric shock to the heart, which enables the heart's
natural pacemaker to regain control and establish a normal heart rhythm.

30. STRENGHT DURING CURVE
• operator selects energy delivered: 50-360 joules, depends on:
– intrinsic characteristics of patient
– patient’s disease
– duration of arrhythmia
– patient’s age
– type of arrhythmia (more energy required for v. fib.)

31. CLASSES OF DISCHARGING WAVWFORM
• There are two general classes of waveforms:
A) mono-phasic waveform
Energy delivered in one direction through the patient’s heart
B) Biphasic waveform
Energy delivered in both direction through the patient’s heart

32. • A monophasic type, give a high-energy shock, up to 360 to 400 joules due to
which increased cardiac injury and in burns the chest around the shock pad sites.
• • A biphasic type, give two sequential lower energy shocks of 120 - 200 joules,
with each shock moving in an opposite polarity between the pads.

33. PRECAUTION
• The paddles used in the procedure should not be placed:-
• on a woman's breasts
• over an internal pacemaker patients.
• Before the paddle is used, a gel must be applied to the patient's skin

34. RISK IN DEFIBRILLATION
• Skin burns from the defibrillator paddles are the most common complication of
defibrillation.
• Other risks include injury to the heart muscle, abnormal heart rhythms, and blood
clots.

35. DRUGS USED IN ACLS
Adenosine
• Narrow PSVT/SVT
• Wide QRS tachycardia, avoid adenosine in irregular wide QRS
• 6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.
Note:
• Rapid IV push close to the hub, followed by a saline bolus
• Continuous cardiac monitoring during administration
• Causes flushing and chest heaviness

36. AMIODARONE
• VF/pulseless VT
• VT with pulse
• Tachycardia rate control
• VF/pulseless VT: 300mg dilute in 20 to 30ml., may repeat 150mg every 3 to 5
minutes
• Stable VT with a pulse: 150mg bolus followed by amiodarone drip (300 mg
should only be used in a code situation)
Note:
• Anticipate hypotension, bradycardia, and gastrointestinal toxicity, Continuous
cardiac monitoring, Very long half-life (up to 40 days), Do not use in 2nd or 3rd-
degree heart block, Do not administer via the ET tube rout

37. DOPAMINE
• Shock/CHF
• 2 to 20 mcg/kg/min
• Titrate to desired blood pressure
Note:
• Fluid resuscitation first
• Cardiac and BP monitoring

38. SOTALOL
• Tachyarrhythmia
• Monomorphic VT
• 3rd line anti-arrhythmic
• 100 mg (1.5 mg/kg) IV over 5 min
Note:
Do not use in prolonged QT

39. BIBLIOGRAPHY
• Willis A Tacker, “External Defibrillators,” in The Biomedical Engineering Handbook,
J. Bronzino (ed) CRC Press, 1995.
• www.google.com
• en.wikipedia.org/wiki/Defibrillation
• http://www.slideworld.org/viewslides.aspx/defibrillator