ACLS 2020 guidlines updates in critical care

acls pathways and related ecgs arythmias

1. Chain of Survival
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Adult Chain of Survival
Immediate recognition of cardiac arrest and
activation of the emergency response system
Early CPR with emphasis on chest compressions
Rapid Defibrillation
Effective advanced life support
Integrated post cardiac arrest care

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High Quality CPR
Start compressions within 10 sec of recognition of cardiac
arrest
Push Hard, Push Fast : atleast 100/min,
atleast 2” or 5cms depth
Allow complete chest recoil after each compression
Minimize interruptions in compressions to < 10sec
Give effective breaths (visible chest rise)
Avoid excessive ventilation

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Technique of airway mgt and ventilation
Open the airway:
Head tilt Chin lift
Jaw Thrust
Ventilation:
Mouth to mask ventilation
Bag Mask Ventilation

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9. Early Defibrillation With an AED
•Turn the AED on.
•Follow the AED prompts.
•Resume chest compressions immediately after
the shock (minimize interruptions).
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10. ACLS-BMS
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11. AED PADS
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13. ACLS-BMS
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14. ACLS-BMS
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15. Use of AED
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18. ACLS
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19. CHAIN OF SURVIVAL
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Goals of resusscitation
To support and restore effective
oxygenation,
ventilation and
circulation
with return of intact neurologic function
ROSC (Return of spontaneous circulation) is an
intermediate goal

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ACLS Survey
Airway
Breathing
Circulation
Differential Diagnosis

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Airway
Is the airway patent ?
Is an advanced airway indicated?
Is proper placement of airway device confirmed?
Is tube secured and placement confirmed frequently?

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Breathing
Are ventilation and oxygenation adequate?
Are quantitative waveform capnography and
oxyhemoglobin saturation monitored?

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Circulation
Are chest compressions effective?
What is the cardiac rhythm?
Is defibrillation or cardioversion indicated?
Has IV/IO access been established?
Is ROSC present?
Is the patient with a pulse unstable?
Are medications needed for rhythm or to maintain BP?
Does the patient need volume(fluid) for resusscitation?

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Differential Diagnosis
Why did this patient develop symptoms
or arrest?
Is there a reversible cause that can be
treated?

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Effective resusscitation team dynamics
Role of Team Leader
Closed Loop Communications
Clear messages
Clear roles and responsibilities
Knowing one’s limitations
Knowledge sharing
Constructive intervention
Reevaluation and summarizing
Mutual respect

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Role of the Team Leader
Organizes the group
Monitors individual performances
Backs up team members
Models excellent team behaviour
Trains and coaches
Facilitates understanding
Focusses on comprehensive patient care

28. AIRWAY
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29. Mask holding
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30. Advanced airway
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31. Combitube
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32. Combitube
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33. CombitubeNo. 1
100 ml
N
o
.
2
1
5

m
l
N
o
.

2
N
o
.

1 No. 1
100 ml
N
o
.

2
1
5

m
l
N
o
.

2
N
o
.

1
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37. Shockable Rythm
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38. Defibrillator
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41. Reversible Causes
"HIT THE TARGET“
H Hypoxia
I Increased H Ions (Acidosis)
T Tension Pneumothorax
T Toxins / Poisons
H Hypovolemia
E Electrolyte Imbalance (Hypo-/Hyperkalemia)
T Tamponade Cardiac
A Acute Coronary Syndrome (MI)
R Raised Intracranial Pressure (Subarachnoid Hemorrhage)
G Glucose (Hypo- / hyperglycemia)
E Embolism (Pulmonary Thrombosis)
T Temperature (Hypothermia)

42. Non shockable rythm
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45. End tidal Carbondioxide (ETCO2)
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46. Medications
•Access for medications
–IV/ IO/Endotracheal
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49. Monitoring during CPR
EtCO2 > 10 mm Hg
Diastolic pressure > 20mm Hg
ScVO2 > 30 mm Hg
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59. IDENTIFY
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60. ?
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?

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79. Thank
You
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