ACLS (4) (1).pptx

Advance cardiac life support management in hospital services

1. Nursing encompasses  autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings . It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people.               ACLS management in hospital services PRESENTED BY- SAYMA KHAN NURSING OFFICER  ELMCH GUIDED BY- DR.ANJALATCHI MUTHUKUMARAN NURSING SUPERINDENTENT   ELMCH, LUCKNOW

2.    ADVANCED CARDIOVASCULAR  LIFE SUPPORT

3. INTRODUCTION..... ACLS refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques. NC .

4. ACLS... These life-threatening conditions range from dangerous arrhythmias to cardiac arrest. ACLS algorithms frequently address at least five different aspects of peri cardiac arrest care- Airway management Ventilation CPR compressions Defibrillation Medications

5. 1-AIRWAY MANAGEMENT Maintain patient airway using the head-tilt, chin-lift. Rescue breathing can be mouth-to-mouth breathing. Or airway management by equipments .

6. This Photo by Unknown author is licensed under CC BY-SA . .

7. 2-VENTILATION In the absence of an advanced airway during CPR, current guidelines based on very limited evidence recommend two positive pressure breaths after every 30 chest compression. These breaths should be of an inspiratory time of 1 s and produce a visible chest wall rise.

8. 3-CPR COMPRESSIONS CPR is an emergency procedure consisting of chest compressions often combined with artificial ventilation. Chest compressions for adults between 5cm and 6cm deep and a rate at least 100 to 120 per minute. Chest compression to breathing ratios is set at 30 to 2 in adults

9. 4-DEFIBRILLATION Defibrillation depolarize the critical mass of myocardial cell at once.  1st paddle on the right of the chest just below the clavicle. 2nd at precordial, region. Paddle should be applied with pressure equivalent to 10kg. Paddle Size- Adult; 13cm Children; 8cm Infant; 4.5cm

10. 5-MEDICATIONS Adrenaline(all types of cardiac arrest) 1mg every 3-5 min. Amidarone (VF,VT)- 1st dose:300mg IV bolus, 2nd dose 150mg. Lidocaine (if amidarone is not available) Sodium bicabonate (only if cardiac arrest is associated with hyperkalemia or tricyclic anti- depressent overdose) Calcium gluconate.

11. ACLS TEAM.. ACLS generally requires a team of trained individuals... Team leader Back up leader 2 CPR performer An airway respiratory specialist An IV access and medication A monitor, defibrillator or ventilator attendant D .

12. JOB RESPONSIBILITIES OF ACLS MEMBERS Understands and are clear about their role assignments. Are prepared to fulfill their role and responsibilities. Have working knowledge regarding algorithms. Have sufficient practice in resuscitation skills. Are committed to the success of the ACLS resuscitation.

13. PRTOCOLS OF CARDIAC ARREST ACC. TO ACLS CPR Quality Push hard (2-2.4″ (5-6 cm)) and fast (100-120 bpm) and allow chest recoil Minimize interruptions Do not over ventilate If no advanced airway, 30:2 compression to ventilation ratio Quantitative waveform capnography If ETCO2 <10 mmHg, attempt to improve CPR quality

14. Shock Energy Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses should be considered. Monophasic: 360 J Return of Spontaneous Circulation Return of pulse and blood pressure Spontaneous arterial pressure waves with intra-arterial monitoring

15. Advanced Airway Supraglottic advanced airway or ET intubation Waveform capnography to confirm and monitor ET tube placement 10 breaths per minute with continuous chest compressions Drug Therapy Epinephrine IV/IO Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes after Amiodarone IV/IO Dose: first dose is 300 mg bolus, second dose is 150 mg Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

16. FLOW CHART OF ACLS UNRESPONSIVE CALL FOR HELP START BLS

17. ATTACH MONITER & DEFIBRRILATOR WHEN AVALIABLE  CHECK RHYTHM 1ST SHOCK (150-200 BIAPHASIC) CPR 30:2 (2min) 2ND SHOCK(150-360)

18. CPR30:2 (2min) ADRENALINE 1MG IV EVERY 3-5 MIN 3RD SHOCK CPR 30:2 (2MIN) IF PULSE PRESENT: START POST RESUSCITATION CARE

19. IF PULSE NOT SEEN FURTHER SHOCK AFTER EACH 2 MIN PERIOD OF CPR. OR  STILL NO PULSE SEEN AND ASYSTOLE SEEN: CONTINUE THE CPR AND SWTICH ON TO NON SHOCKABLE TREATMENT.