Advanced Cardiac Life support ppt2021.pptx

this course is designed for EMT intermediate students

1. Advanced Cardiac Life support ( ACLS) 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 1/3 rd 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.

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20. Defibrillation Know your AED Universal steps : Power ON Attach electrode pads Analyze the rhythm 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

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

29. Asystole

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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

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

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

39. . Adult Post–Cardiac Arrest Care Algorithm.

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

41. Pediatric Cardiac Arrest Algorithm.

42. THANK YOU PEACE FOR ETHIOPIA

43. REFRENCES ACLS 2020 ACLS 2015