ACLS Summary: Breathing:
Chapter One: Overview of ACLS:
1- Give supplemental oxygen when needed:
For cardiac arrest patient, give 100% oxygen.
Factors associated with improved survival in patients with cardiac arrest: For other patients, adjust the oxygen administration to achieve an
oxygen saturation of 95% and above.
- Rapidly recognizing sudden cardiac arrest.
For ACS patients, 90% is acceptable.
- Immediately providing high quality CPR.
For post cardiac arrest 92% to 98% is acceptable.
- Defibrillating immediately when the device is available.
2- Monitor the adequacy of ventilation and oxygenation by: Clinical criteria
- Providing goal directed and time sensitive post cardiac arrest care.
(chest rise and cyanosis), quantitative waveform capnography, and O2
Chain of survival elements: saturation.
- Prevention and early recognition of cardiac arrest and rapid response. Circulation:
- Activation of emergency system.
1- Monitor CPR Quality:
- High quality CPR including defibrillating for VF and PVT.
Quantitative waveform capnography: if PETCO2 if less than
- Advanced resuscitation interventions, including medications and advanced airway
10mmHg, improve CPR quality. A sudden increase in ETCO2 to more
interventions.
than 25mmHg may indicate ROSC. If intra arterial pressure is less
- post cardiac arrest care, including critical care interventions and targeted
than 20mmHg, improve CPR quality.
temperature management.
Monitor ECG rhythms: attach the patient to the monitor/ defibrillator.
- Recovery.
Provide defibrillation/ cardioversion when needed.
Post resuscitation details: Obtain IV/IO access and give appropriate drugs to manage rhythm and
blood pressure.
- TTM. Check blood glucose level and body temperature.
- Pyrexia. Check perfusion issues.
- Coronary angiography.
- Coronary reperfusion. Disability: Check for the patient’s neurologic function, LOC, and pupil dilation. You can use the
scale AVPU: Alert, Voice, Painful, and Unresponsiveness.
Contraindications of Aspirin (162-325mg) in STEMI:
Exposure:
- History of Aspirin allergy.
- Recent GI bleeding within the last 3 months. Remove clothing to perform physical examination.
Look for obvious signs of trauma, bleeding, burns, unusual markings,
Systematic resuscitation approach: and medical alert bracelets.
- Initial assessment, visualization, and scene safety. High quality CPR:
- BLS assessment.
- Primary assessment ABCDE. - Chest compressions at depth of 5-6cm, rate of 100-120 bpm.
- Secondary assessment, SAMPLE, H’s, and T’s. - Allow the chest to completely recoil after each compression.
- Switch compressors every 2 minutes or when fatigued.
Note: - Minimize interruptions of compressions, no more than 10 seconds.
- Avoid Excessive ventilations.
- When the patient is unconscious, use BLS assessment immediately, then use
primary and secondary assessments for advanced evaluation after. Secondary Assessment:
- When the patient is conscious, start with the primary assessment.
1- SAMPLE:
BLS assessment: Signs and symptoms: breathing difficulty, tachypnea, tachycardia,
fever, headache, abdominal pain, and bleeding.
- Check responsiveness.
Allergies: medications, food, or latex, and their associated reactions.
- Call for help/ activate emergency system and get the AED/defibrillator.
Medications, including last dose taken and over the counter
- Check for pulse and breathing, at least 5 seconds, but no more than 10 seconds.
medications.
When the patient has no pulse and not breathing, start chest compressions. When the
Past medical history: previous illnesses, surgeries, and
patient is not breathing, but has a pulse, start rescue breaths, 1 breath every 6
hospitalizations, family history (in cases of ACS and stroke), and
seconds.
immunization status.
- Recheck pulse and breathing every 2 minutes.
Last meal consumed and the approximate time was taken.
- Defibrillation: if pulse is not felt, follow AED instructions.
Events:
Primary Assessment: o Events leading to current illness of injury (onset: sudden
or gradual, type and mechanism of injury).
Airway: maintain an open airway in unconscious patients by using head tilt chin lift, an
o Hazards at scene.
oropharyngeal airway, or a nasopharyngeal airway.
Chapter One: Overview of ACLS:
1- Give supplemental oxygen when needed:
For cardiac arrest patient, give 100% oxygen.
Factors associated with improved survival in patients with cardiac arrest: For other patients, adjust the oxygen administration to achieve an
oxygen saturation of 95% and above.
- Rapidly recognizing sudden cardiac arrest.
For ACS patients, 90% is acceptable.
- Immediately providing high quality CPR.
For post cardiac arrest 92% to 98% is acceptable.
- Defibrillating immediately when the device is available.
2- Monitor the adequacy of ventilation and oxygenation by: Clinical criteria
- Providing goal directed and time sensitive post cardiac arrest care.
(chest rise and cyanosis), quantitative waveform capnography, and O2
Chain of survival elements: saturation.
- Prevention and early recognition of cardiac arrest and rapid response. Circulation:
- Activation of emergency system.
1- Monitor CPR Quality:
- High quality CPR including defibrillating for VF and PVT.
Quantitative waveform capnography: if PETCO2 if less than
- Advanced resuscitation interventions, including medications and advanced airway
10mmHg, improve CPR quality. A sudden increase in ETCO2 to more
interventions.
than 25mmHg may indicate ROSC. If intra arterial pressure is less
- post cardiac arrest care, including critical care interventions and targeted
than 20mmHg, improve CPR quality.
temperature management.
Monitor ECG rhythms: attach the patient to the monitor/ defibrillator.
- Recovery.
Provide defibrillation/ cardioversion when needed.
Post resuscitation details: Obtain IV/IO access and give appropriate drugs to manage rhythm and
blood pressure.
- TTM. Check blood glucose level and body temperature.
- Pyrexia. Check perfusion issues.
- Coronary angiography.
- Coronary reperfusion. Disability: Check for the patient’s neurologic function, LOC, and pupil dilation. You can use the
scale AVPU: Alert, Voice, Painful, and Unresponsiveness.
Contraindications of Aspirin (162-325mg) in STEMI:
Exposure:
- History of Aspirin allergy.
- Recent GI bleeding within the last 3 months. Remove clothing to perform physical examination.
Look for obvious signs of trauma, bleeding, burns, unusual markings,
Systematic resuscitation approach: and medical alert bracelets.
- Initial assessment, visualization, and scene safety. High quality CPR:
- BLS assessment.
- Primary assessment ABCDE. - Chest compressions at depth of 5-6cm, rate of 100-120 bpm.
- Secondary assessment, SAMPLE, H’s, and T’s. - Allow the chest to completely recoil after each compression.
- Switch compressors every 2 minutes or when fatigued.
Note: - Minimize interruptions of compressions, no more than 10 seconds.
- Avoid Excessive ventilations.
- When the patient is unconscious, use BLS assessment immediately, then use
primary and secondary assessments for advanced evaluation after. Secondary Assessment:
- When the patient is conscious, start with the primary assessment.
1- SAMPLE:
BLS assessment: Signs and symptoms: breathing difficulty, tachypnea, tachycardia,
fever, headache, abdominal pain, and bleeding.
- Check responsiveness.
Allergies: medications, food, or latex, and their associated reactions.
- Call for help/ activate emergency system and get the AED/defibrillator.
Medications, including last dose taken and over the counter
- Check for pulse and breathing, at least 5 seconds, but no more than 10 seconds.
medications.
When the patient has no pulse and not breathing, start chest compressions. When the
Past medical history: previous illnesses, surgeries, and
patient is not breathing, but has a pulse, start rescue breaths, 1 breath every 6
hospitalizations, family history (in cases of ACS and stroke), and
seconds.
immunization status.
- Recheck pulse and breathing every 2 minutes.
Last meal consumed and the approximate time was taken.
- Defibrillation: if pulse is not felt, follow AED instructions.
Events:
Primary Assessment: o Events leading to current illness of injury (onset: sudden
or gradual, type and mechanism of injury).
Airway: maintain an open airway in unconscious patients by using head tilt chin lift, an
o Hazards at scene.
oropharyngeal airway, or a nasopharyngeal airway.
