Basic Life Support (BLS) Advanced Life Support (ALS) Dr. Yasser
Mostafa Prof. of Chest Diseases Ain Shams University.
Slide 2
The 2011 ACLS guideline addressed the following aspects of the
vital fourth link of the chain of survival: Immediate actions
following cardiac arrest Airway Breathing (ventilation) Supporting
the Circulation during cardiac arrest Peri-arrest arrhythmias
Identifying reversible causes Post-resuscitation care Organ
donation. Cardiac Arrest Managment
Slide 3
Cardiac Arrest management The principles of good resuscitation
practice require clear emphasis. The foundations of advanced
cardiac life support include the following: Consistent performance
of high-quality CPR: Early defibrillation in the presence of VF /
pulseless VT An organised system of ACLS management Integrated
post-cardiac arrest care
Slide 4
Cardiac Arrest management Consistent performance of
high-quality CPR : Each compression to be at least 5 cm depth and
at a rate of 100 per minute with complete chest recoil after each
compression, minimizing interruptions to chest compressions
Ventilating at 30:2 in absence of advanced airway, and continuous
chest compressions with ventilations interposed every 6 8 seconds
with either an ETT or a supraglottic airway Implementing monitoring
of CPR quality as part of the culture of good resuscitation
practice.
Slide 5
Slide 6
DEFIBRILLATION The aim of defibrillation is to depolarise the
myocardium to hopefully allow the native pacemakers to restore a
normal rhythm. There are strategies to improve current flow across
the chest
Slide 7
Paddles vs pads Several studies have compared handheld paddles
with self-adhesive pads and generally find higher reversion rates
with pads. Moreover, hands-free pads have simplicity and safety
advantages.
Slide 8
Paddles vs pads
Slide 9
Paddle/pad position Commonly, one pad is placed at the right
parasternal area (second intercostal space) and the other in the
mid-axillary line (sixth intercostal space). If there is a
pacemaker/ICD box, the pad/paddle should be at least 8 cm away from
it.
Slide 10
Monophasic/biphasic defibrillators There are various electrical
waveforms that can be produced by these machines and newer devices
produce a biphasic electrical discharge, which is probably superior
in terms of reversion rates. In VF/VT, biphasic shocks should be
delivered at 150 J and monophasic at 360 J. If you are not certain
what sort of device you have, it is generally the case that the
maximum possible on a biphasic is 150200 J (for monophasic its 360
J).
Slide 11
Cardiac Arrest management Early defibrillation in the presence
of VF /Pulseless VT For monophasic defibrillation at 360 joules per
shock For biphasic defibrillation with an initial dose of between
150 joules with consideration for escalating higher energy
defibrillation up to a maximum of 360 joules, if desired. Every
shock to be followed immediately by at least 1 minute of good
quality CPR
