Complete ACLS Review Series

Introduction

• Presenter: Eddie Watson
• Goal: Simplify critical care subjects, particularly ACLS, to boost confidence for ICU practitioners.
• Offers: C credits via ICU Advantage Academy membership and notes access.

Overview of ACLS

• ACLS (Advanced Cardiac Life Support) guidelines and best practices by AHA.
• Aim: Improve patient outcomes in life-threatening situations.
• Importance: Understanding ACLS is crucial for ICU practitioners.

Systematic Approach of ACLS

• Support oxygenation, ventilation, and circulation.
• Initial Impression: Determine if patient is conscious and assess situation.
• Basic Life Support (BLS): Foundation of ACLS algorithms.
  • Assess breathing and circulation.
  • If unconscious, activate emergency response and start BLS assessment.
• Systematic assessment involves ABCDE approach:
  • Airway: Maintain using head tilt-chin lift, consider advanced airway.
  • Breathing: Support with bag valve mask, monitor SATs.
  • Circulation: Ensure proper CPR, check IVIO access, administer appropriate drugs.
  • Disability: Check neurological function.
  • Exposure: Inspect for trauma or other conditions.
• Secondary Assessment: Focuses on evaluating potential causes and medical history.

Reversible Causes of Cardiac Arrest (H's and T's)

• Understanding and memorizing these causes is vital.
• H's: Hypovolemia, Hypoxia, Hydrogen ions (Acidosis), Hypo/Hyperkalemia, Hypoglycemia, Hypothermia.
• T's: Toxins, Cardiac Tamponade, Tension Pneumothorax, Thrombus, Trauma.
• Key: Treat reversible causes to aid recovery and prevent future arrest.

Cardiac Arrest Algorithm

• For pulseless patients in cardiac arrest: VFib, pulseless VT, PEA, Asystole.
• Left Branch (shockable rhythms): Deliver shock, CPR, administer Epi and Amiodarone.
• Right Branch (non-shockable rhythms): CPR, administer Epi, assess reversible causes.
• Continuous assessment for ROSC (Return of Spontaneous Circulation).

Bradycardia Algorithm

• For symptomatic bradycardia with pulse.
• Initial assessment: Ensure less than 50 bpm and symptoms present.
• Treat with Atropine, transcutaneous pacing, or dopamine/epinephrine.

Tachycardia Algorithm

• For symptomatic tachycardia with rate over 150 bpm.
• Evaluate rhythm (narrow/wide QRS, regular/irregular).
• Treat unstable tachycardia with synchronized cardioversion.
• Medications like Adenosine for specific rhythms.

Post-Cardiac Arrest Care

• Focus on optimizing ventilation, oxygenation, and treating hypotension.
• Ensure airway support and manage breathing and circulation.
• Consider targeted temperature management if patient is unresponsive.
• Transfer to ICU for ongoing management.

ACS and Stroke Algorithms

• ACS (Acute Coronary Syndrome): Recognition, initial intervention, and reperfusion.
  • Identify signs of MI, initiate treatment (e.g., aspirin, nitroglycerin).
  • Reperfusion therapy via Cath lab or fibrinolytics.
• Stroke: Identification, initial management, and rapid intervention.
  • Use FAST acronym to identify signs.
  • Key steps within 60 minutes: CT scan, evaluation for TPA.

Conclusion

• Emphasis on memorizing algorithms for quick application in critical situations.
• Importance of continuous learning and reviewing AHA guidelines post-certification.