Material presented here is for informational purposes only & is not a substitute for formal ACLS training, nor is it intended as advice or directions for delivering medical treatment. Established practices at your institution may vary from the information presented here.
The algorithms basically are in terms of too fast, too slow, and dead rhythms and continuing with the stroke and acute coronary syndromes as well.
We will take the approach with all Algorithms of an unconsious patient as the BLS: CABD and if patient is conscious Primary (ABCDE) and Secondary (5Hs and 5Ts) surveys.
If patient is unconscious BLS (Basic Life Support):
C=Check for responsiveness and no breathing or abnormal breathing and Call code blue or
9-1-1 and Check Circulation (no more than 10 seconds) - If definite pulse not felt. Begin
Chest compressions for pulseless patient - hard and fast 100 - 120 beats per minutes,
A=Airway, Open airway using head - tilt - chin lift (if no trauma suspected)
B=Breathing, Breath for pt - 2 breaths - (each breath should cause chest rise - but wait no more
than 10 seconds)
5 cycles (2 minutes) then
D=Defibrillation, Check for and tx a shockable rhythm (V.fib/V.tach are the only two shockable rhythms, see Unstable Tachycardias for Cardioversion options (120-200Joules for biphasic defibrillators and 360J for monophasic defibrillators)
C=Circulation - After shock - resume CPR with chest compresions and when advanced personnel arrive:
This moves into ACLS, place (intravenous device) IV. Antecubital vein is 1st choice/IO (intraosseous) route is an accepatible alternative and give medications (Vasopressors) - CPR for 5 cycles/2 minutes - meds (Antiarrhythmics)
- A=Airway - Is the airway open and patent? If not, secure the an airway with an advanced airway device.
- B=Breathing - Are ventilation and oxygenation adequate? Place on oxygen and/or confirm placement with capnography.
- C=Circulation – Is CPR resumed with chest compressions? Has an (intravenous device) IV been placed? Antecubital vein is 1st choice for peripheral line/IO (intraosseous) route is an acceptable alternative and give medications (Vasopressor) - CPR for 5 cycles/2 minutes - meds (Antiarrhythmic). No interruptions from CPR for more than 10 seconds.
- D=Disability - What is the patient's neurologic funtion? AVPU - Alert, Voice, Pain, Unresponsive
- E=Exposure - Remove all clothing to access for any potential problem.
SAMPLE=Signs and Symptoms, Allergies, Medications, Past medical history, Last meal eaten, Events (what happened) - look for 5 Hs and 5 Ts: Hypovolemia, Hypoxia, Hydrogen Ion (Acidosis), Hypo/hyperkalemia (low or high K level), Hypothermia, & Tension Pneumothorax, Tamponade-cardiac, Toxins (overdose - see PEA for tx), Thrombosis-pulmonary (Pulmonary Embolism-PE), Thrombosis-cardiac (Myocardial Infarction-MI).