this course is designed for EMT intermediate students

1. By Andualem

2. objectives
 After the course you will be able to
• Define advanced cardiac life support
• Describe chain of survival
• Discus cardiac arrest algorisms
• Explain management of cardiac arrest
• Describe post cardiac arrest care
2

3. Basic ECG
What is an ECG?
The electrocardiography (ECG) is a surface representation of the
electrical events of the cardiac cycle.
Each event has a distinctive waveform, the study of which can lead to
greater insight into a patient’s cardiac pathophysiology.

4. The normal anatomy of the heart

5. The Normal Conduction System
 .

6. Impulse Conduction & the ECG
 Sinoatrial node
 AV node
 Bundle of His
 Bundle Branches
 Purkinje fibers

7. .
 .
Normal conduction system

8. ACLS(Advanced Cardiac Life Support)
 It is a set of clinical interventions for the urgent treatment of cardiac arrest and
other life-threatening medical emergencies, as well as the knowledge and skills to
deploy those interventions.
 It is Systematic approach to assessment and management of cardiopulmonary
emergencies
 Continuation of Basic Life Support(BLS)
 Resuscitation efforts aimed at restoring spontaneous circulation and retaining
intact neurologic function

9. AHA Adult Chain of Survival
 1. Immediate recognition of cardiac arrest and
 activation of the emergency response system
 2. Early CPR with an emphasis on chest
 compressions
 3. Rapid defibrillation
 4. Effective advanced life support
 5. Integrated post–cardiac arrest care

10. COMPONENT OF BLS SEQUENCE AND HIGH
QUALITY CPR
 Scene safety:
 1. Make sure the environment is safe for rescuers and victim
 Recognition of cardiac arrest:
 1. Check for responsiveness
 2. No breathing or only gasping ( ie, no normal breathing)
 3. No definite pulse felt within 10 secs ( Carotid or femoral pulse)
 4. (Breathing and pulse check can be performed simultaneously within 10
secs)

11. Activation of emergency response system:
 If alone with no mobile phone, leave the victim to activate the emergency response
system and get the AED before beginning CPR
 Otherwise, send someone and begin CPR immediately; use the AED as soon as it is
available

12. WITNESSED VS UNWITNESSED
 • WITNESSED
 • IF ALONE
 • ACTIVATE EMS
 • THEN CPR
 • IF 2 RESCUERS
 • START CPR
 • SECOND ONE – ACTIVATE EMS
 • UNWITNESSED
 • START CPR
 • GIVE FOR 2 MINS
 • ACTIVATE EMS

13. .
 Chest compression-
 Adult- 30:2
 Children or infant- 30:2 if one rescuer
 15:2 if more than one rescuer
 Compression rate:
 100-120/ min
 Compression depth:
 Adult- at least 5 cm
 Children or infant- at least 1/3rd AP diameter of chest

14. .
 Hand placement:
 Adult - 2 hands on the lower half of the sternum
 Children – 1 or 2 hands on the lower half of the sternum
 Infants – 2 fingers or 2 thumb defending of the number of
 rescuers
 Chest recoil:
 allow full recoil of chest after each compression; do not
 lean on the chest after each compression.
 Minimizing interruption: Limit interruptions in chest compressions to less than 10
secs.

15. .

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20. Defibrillation
 Know your AED
 Universal steps:
1. Power ON
2. Attach electrode pads
3. Analyze the rhythm
4. Shock (if advised)
20

21. Defibrillation
 Most frequent initial rhythm in witnessed sudden cardiac arrest is
ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)
which rapidly deteriorates into VF
 The only effective treatment for VF is electrical defibrillation
 Probability of successful defibrillation diminishes rapidly over time.
 VF rapidly converts to asystole if not treated
21

22. Early Defibrillation = Increased Survival
22

23. Rhythm Analysis
Lethal vs non-lethal?
Shockable vs. non-shockable? Too fast vs too slow?
Symptomatic vs. asymptomatic?

24. Lethal Rhythms
 Shockable (Defibrillation)
 Ventricular fibrillation(most frequent initial rhythm in witnessed sudden cardiac
arrest).
 Pulseless ventricular tachycardia
 Non-shockable
 Asystole
 Pulseless electrical activity(PEA)
24

25. Ventricular tachycardia

26. Ventricular fibrillation

27. .

28. Pulseless Electrical Activity(PEA)
Note that PEA can look like any rhythm(any organized activity) but no pulse

29. Asystole

30. .

31. .

32. Non-Lethal Rhythms
 Too fast (tachycardias)
• Sinus
• Supraventricular (including a-fib/flutter)
• Ventricular
 Too slow (bradycardias)
• Sinus
• Heart block (1°, 2°, 3° AV block)
32

33. Adult advanced cardiovascular life support Cardiac Arrest
Algorithm

34. Adult cardiac arrest
shout for help/activate emergency team

35. Second cycle
Third cycle

36. .
Asystole/PEA
simplified:
-CPR and check for
shockable rhythms
-Epinephrine every 3-
5 mins
-Search for reversible
causes

41. Give fluids!
Give oxygen!
Consider bicarb!
Consider calcium!
Consider warming!
Needle decompression!
Pericardiocentesis!
Consider antidotes!
Thrombolysis?

42. Fluids
Oxygen
Feel patient
Bilateral breath sounds
No JVD/unlikely hx
Cardiac arrest patient
Do routine ACLS
Bicarb? Calcium? Thrombolysis?

43. .
Adult Post–Cardiac Arrest Care Algorithm.

44. Cardiac Arrest in Pregnancy In-Hospital ACLS
Algorithm.

45. Pediatric Cardiac Arrest Algorithm.

46. THANK YOU
PEACE FOR ETHIOPIA

47. REFRENCES
 ACLS 2020
 ACLS 2015