advanced Cardiac life support (ACLS), Shockable -non-shockable rhythm

Mastering Life-Saving Skills: Advanced Cardiac Life Support (ACLS)"

Unlock the critical knowledge and skills required to save lives in emergency situations! This presentation dives into the core principles of ACLS, equipping you with expert techniques to recognize and manage cardiac emergencies effectively. Whether you're a seasoned healthcare professional or new to the field, this session will enhance your confidence in delivering high-quality care during life-threatening scenarios.

Join for an engaging and interactive exploration of evidence-based protocols, team dynamics, and the latest updates in ACLS guidelines. Because when seconds matter, preparation makes the difference!

1. Advanced Cardiac Life Support DR OMKAR KC

2. Objectives Chain Of Survival Chest compressions Airway & breathing Defibrillation Drugs Sequence of Advanced Cardiac Life Support ACLS in Covid-19 patients

3. Chain of Survival (2020)

4. C – A – B Chest compressions and early defibrillation. Chest compressions

5. Chest Compressions 30 CHEST COMPRESSIONS

6. Place the heel of one hand in the centre of the chest Place other hand on top Interlock fingers Compress the chest Rate at least 100-120/min Depth at least 5 cm (2 inches) Equal compression : relaxation Chest Compression

7. CPR Quality Push hard ( at least 2 inches/5cm) and fast (100-120/min) and allow complete chest recoil Minimize interruption in chest compressions. Avoid excessive ventilation Change compressor every 2 minutes or sooner if fatigued If no advance airway, 30:2 compression-ventilation ratio Quantitative waveform capnography -If PETCO2 is low or decreasing reassess CPR quality

8. Airway and Breathing Airway – To open the airway use Head Tilt-Chin Lift Jaw Thrust

9. Airway Equipments AMBU BAG Anaesthesia Mask Guedel’s Airway Nasopharyngeal Airway Endotracheal Tube Laryngeal Mask Airway

10. Use of Advanced Airway Endotracheal intubation or supraglottic advanced airway Waveform capnography or capnometry to confirm and monitor ET tube placement Once advanced airway in place give 1 breath every 6 seconds (10 breaths/min) with continuous chest compression For BVM ventilation: with oxygen supplement 100%, chest should be visibly rise during breaths (a tidal volume of 10 ml/kg) Ventilation asynchronized with chest compressions

11. Capnography Increased emphasis on the use of capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide an early indication of return of spontaneous circulation (ROSC)

12. Capnography to confirm endotracheal tube placement . Capnography to monitor effectiveness of resuscitation efforts. Capnography Waveform Capnography Waveform

13. Drugs Adrenaline 1mg iv every 3-5 minutes Amiodarone First dose: 300mg bolus Second dose:150mg OR Lignocaine First dose: 1-1.5mg/kg iv Second dose: 0.5-0.75 mg/kg

14. Shock Energy for Defibrillation Biphasic Manufacturer recommendation( eg . Initial 120-200 J/150 – 200 – 250J), I f unknown use maximum available Second and subsequent doses should be equivalent or higher doses may be considered Monophasic : 360 J

15. Adult Cardiac Life Support

16. Shockable rhythms

17. Ventricular fibrillation

18. Pulseless VTs (PVT)

19. Defibrillation Effective chest compression with breathing Once Defibrillator is available: shock and chest compression After third shock: shock followed by chest compression & drugs

20. Drug/s Give Adrenaline 1 mg after third shock then every 4 minutes Amiodarone 300 mg can be given delivered simultaneously along with the adrenaline Further dose of amiodarone 150 mg is delivered in resistant / refractory cases

21. Drugs Use lidocaine in absence of amiodarone Use magnesium for ‘ torsades de pointes’ Continue high quality CPR

22. Non- shockable rhythms

23. Asystole

24. PEA / EMD

25. Drugs Adrenaline is the only drug for non Shockable rhythms Dose: 1 mg every 4 minutes High quality CPR Find the reversible causes of arrest in the line of ‘H’s and ‘T’s and manage accordingly

26. Return of Spontaneous Circulation (ROSC) Pulse and blood pressure Abrupt sustained increase in PETCO2 (typically ≥ 40mm Hg) Spontaneous arterial pressure waves with intra-arterial monitoring Post Cardiac Arrest Care

27. Reversible causes of Cardiac Arrest 5 H Hypoxia Hypovolemia Hypo/ Hyperkalemia Hypothermia H +ions (Metabolic acidosis) 5 T Tension pneumothorax Tamponade Toxins Thrombosis (coronary) Thrombosis (pulmonary)

28. Management of reversible causes Hypoxia: Oxygenation and ventilation Hypovolemia : Fluid and I/O charting Hypokalemia : potassium supplement Hyperkalemia : Calcium Gluconate Hypothermia: Warming (Use of warm fluids, warmers) H +ions (Metabolic acidosis): Sodium Bicarbonate Glycaemic control: Dextrose supplement/ Insulin

29. Management of reversible causes Tension pneumothorax: Chest Tube Cardiac Tamponade : Pericardiocentesis Toxins: Antidotes Thrombosis (coronary) Thrombosis (pulmonary) Thrombolysis

30. Fluid bolus of 20 cc/kg

31. CPR in COVID-19 Patients Don PPE LIMIT personnel Provide rescue breathing using bag-mask device with filter and tight seal Intubation by expert Minimize closed circuit disconnection

32. Questions????

33. Thankyou !