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 unconscious patient as the BLS: CABD and if patient is conscious Primary (ABCs) and Secondary (5Hs and 5Ts) surveys.
If patient is unconscious BLS (Basic Life Support):
Primary Assessment:
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,
30 compressions
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)
Secondary Assessment:
- C=Circulation – Is CPR resumed with chest compressions? Has an (intravenous device) IV been placed? Antecubital vein is 1st choice for peripheral line and is preferred over IO (intraosseous) route - IO is also an acceptable alternative if an IV cannot be obtained. - CPR for 5 cycles/2 minutes - meds (Vasopressor and consider an Antiarrhythmic). No interruptions from CPR for more than 10 seconds.
- 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 > 10 mmHg should be expected or chest compressions are not doing well enough (ROSC - should see a jump back up to 35 mmHg). 1 breath every 6 seconds
- D=Determine the cause - 5Hs and 5Ts - hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade-cardiac, toxins (overdose), thrombosis-pulmonary (PE), thrombosis-cardiac (MI). Remove clothing to be able to assess the patient.
If Patient is awake, breathing with a pulse, then provide: A, B, Cs. Oxygen if needed, get a set of vital signs, put patient on a heart monitor.
Assessment: SAMPLE=Signs and Symptoms, Allergies, Medications, Past medical history, Last meal eaten, Events (what happened)
