acls pre course work

acls pre course work

Advanced Cardiac Life Support (ACLS) Pre-Course Work: A Comprehensive Guide

1. Introduction to ACLS

Residents, fellows, hospitalists, intensivists, emergency medicine providers, and any provider taking care of patients with life-threatening cardiac emergencies need to undergo this important training. Upon successful completion of ACLS, a provider card is issued for a period of two years.

The bundling of these cognitive, skill, and psychomotor aspects of the total learning experience into competency is what ACLS is fundamentally about. Achieving competence in ACLS training will enable any healthcare provider to serve in a clinical setting regardless if the curved yellow arrow calls them to do it while at work, at play, or ensuring the safety of all. As the instructor, it is essential to ensure that future ACLS certificate holders validate their skills during their renewals.

In 2013, the American Heart Association ACLS guideline was updated and essentially has remained stable since then. The current resuscitation guidelines for advanced cardiac life support for shockable rhythms consist of the following: perform high-quality cardiopulmonary resuscitation (CPR), deliver rapid defibrillation, perform advanced airway management, administer IV/IO medications, assess, deliver advanced management interventions when appropriate, and for the care of post-cardiac arrest patients.

Advanced Cardiac Life Support (ACLS) refers to a set of clinical interventions for the urgent treatment of life-threatening cardiac emergencies. This life-saving training has been historically taught over the past four decades in the American Heart Association format. The training consists of a combination of didactic and psychomotor skills directed at teaching a plethora of clinical skills frequently essential in saving lives.

2. Key Concepts in ACLS

2.3 Cardiovascular H’s and T’s In the patient with a non-shockable rhythm, it is important to make a prompt diagnosis because unless the patient is undergoing CPR for opioid or perhaps amphetamine overdose, the patient is depending on your skills. We can all look at the rhythm and realize that there is a problem. It can be from the heart (H’s) or it may not be from the heart (T’s). Because the H’s cause a more global threat to the patient when considering the groups, it is: Hypoxia, hypovolemia, hydrogen ion acidosis, hyper/hypokalemia, hypothermia, tension pneumothorax, tamponade, and toxin or thrombus (some include cardiac tamponade under “H”), making up the H’s and T’s.

Section 2.2 Standard CPR Concepts CPR: The essentials of CPR must not be overlooked. Most of us work in institutions where the best patient outcomes in ACLS are 50%, and close to it is the likely survival rate if high-quality CPR is being performed. CPR is not just a series of protocols to follow and then we “get the patient back” and you now have ALS, but a command task that involves every aspect of the healthcare team. Good chest compressions are best achieved by professionals respecting the various responsibilities of the individuals who are doing different tasks. Someone is always in charge, and everyone has a specific task. Timekeepers are necessary because we all estimate time differently. Dive bombers generally are not as effective because they tire more easily, so rotating personnel is important. Many patients with cardiac arrest appear non-responsive. If you have a patient with agonal respiration, shout and are hard to arouse, consider this possibility and feel the patient’s pulse. The absence of central pulses is a poor prognostic sign. It is important to compress the chest to the appropriate depth. If you are unsure if you are compressing deeply enough, other rescuers should stop what they are doing, especially talking (!), and have a look at what you are doing from the opposite side of the patient. If work is being done on the patient, that person should move back from the bed so as to move away from the vibrating end. The depth would then be checked against the guidelines.

2.1 Chest Pain “When in doubt, assume heart disease and treat accordingly.” Practically every chest pain patient should be placed on a cardiac monitor as this will provide valuable information. Also, some chest pain patients may require ACLS protocols at some point. Factors that might suggest a cardiovascular problem are: • Exertional association • Diaphoresis • Dyspnea • Chest radiation • Chest pressure • Nausea/Vomiting • Asymmetry/radiation If the patient is less than 30 years of age, the chest pain is pleuritic, and/or associated with diaphoresis, cough, or failed crunch, the chest pain is less likely of cardiovascular origin. The most common cause of chest pain is emotional or exertional stress, which causes an acute anxiety state. Other overlooked causes: Postop patient, upper abdominal irritation, dental problems, musculoskeletal trauma, fascia irritation. If the underlying cause of the chest pain is unclear, then the use of ASA might be helpful as long as the chest pain is not caused by a possible contraindication to its use.

Objectives At the end of this module, the course participant can: • Discuss a systematic approach to the adult patient with chest pain. • Recognize cardiac arrest. • Describe the importance of good CPR on survival. • Define the H’s and T’s of the cardiovascular and respiratory systems.

Key Concepts in ACLS

Advanced Cardiac Life Support (ACLS) Pre-Course Work: A Comprehensive Guide

3. ACLS Algorithms and Protocols

Epinephrine: intravenous drug therapy in prolonged cardiac arrest should be emphasized. After the first card that does not become effective, give the patient one of two dosage echinopinephine via a peripheral vein every 3-5 minutes. After IV or IO access is acquired and no advanced airway is in place, follow each dose with a 20ml dose of benign normal saline and consider vasopressin.

Pharmacology Objectives

Supplemental oxygen: provide oxygen to achieve an altitude of at least 94%, even up to 100%, during and after cardiac resuscitation whenever feasible.

Bag-mask ventilation: it should be applied to an advanced airway control device new place and can be used to check for correct placement.

Breathing Objectives

An endotracheal tube should be removed from the trachea if return to a spontaneous, sustained, organized rhythmic cardiac output has occurred.

Endotracheal Tube

Airway management: Basic and advanced airway management using initiation techniques, surgical airways, and positioning considerations.

Airway Objectives

In BLS survey, if the person doesn’t respond, call someone to get the emergency response team. Activate it to get help. If you are alone, call 911 or send someone to call 911. Return and provide help. Check the patient’s pulse and rhythm.

Basic Life Support (BLS) Survey

ACLS is a crucial part of the chain of survival, treating cardiovascular conditions and delivering high-quality care. All patients can benefit from evidence-based care, and guidelines help healthcare professionals apply the most effective treatments.

ACLS is based on the fundamentals of Basic Life Support (BLS), including high-quality cardiopulmonary resuscitation (CPR), early defibrillation, and early advanced cardiovascular life support. ACLS guidelines are based on critical assessment of the most current basic and clinical evidence.

Introduction

3. ACLS Algorithms and Protocols

Advanced Cardiac Life Support (ACLS) Pre-Course Work: A Comprehensive Guide

4. Practical Skills and Simulations

The sequence of resuscitation is: check the responsiveness of the victim, breathe only if the victim is not breathing or there is agonal breathing, call for help, check the victim’s pulse after a brief reference and begin the compressions of the heart or direct control which must be displayed. The ACLS modified algorithm includes these basic steps and adds a control of rapid breaths in the event of a sudden death of arrival to the emergency department before the presence of emergency equipment. Rapid sequence induction intubation should maximize the passage of the tube and reduce the hypoxia time. Respiratory care should include bag and mask ventilation or endotracheal tube, intubation, or cricothyrotomy. Vascular access should include peripheral vascular access, and intraosseous cannulations when necessary. Drug therapy should include treatment preferences vasopressor, arrhythmias with pulse and arrhythmias without pulse.

5. Assessment and Certification

Certification criteria have been established and are consistent with widely held beliefs regarding minimum acceptable performance standards for ACLS students. Requirements for instructor renewal are included in the Instructor Guidelines. These guidelines, when taught along with the text of the Student Package, are an important tool for any facility in evaluating the ACLS program and students’ performance standards.

Instructor guidelines include a variety of teaching methods and recommendations for monitoring student performance in both the cognitive and psychomotor skills tested components of the ACLS course. These criteria recognize the extreme importance of monitoring and assessing the students throughout the course to ensure a safe environment for the students and patients, as well as to provide each student the opportunity to comprehend, practice, and exhibit the essential cognitive and psychomotor skills.

For the use of this course to be most effective, it is assumed that the student who begins the course will have detailed knowledge pertaining to the techniques of basic life support. There are no educational prerequisites for participation in an ACLS course. Nevertheless, a background that includes basic life support training can greatly facilitate learning while participating in an ACLS course.

Advanced Cardiac Life Support (ACLS) was developed based on two aims: first, to improve survival and neurological recovery of patients following cardiac arrest and cardiopulmonary complications; second, to better the survival rate and neurological function of individuals who exhibit cardiopulmonary abnormalities placing them at risk for sudden cardiac death.