ICU Advantage: Complete ACLS Review Series

Introduction

• Presenter: Eddie Watson from ICU Advantage
• Goal: Simplify complex critical care topics, particularly ACLS (Advanced Cardiac Life Support).
• Content: Complete ACLS review series including reversible causes of cardiac arrest.
• Opportunities: Earn C credits by joining ICU Advantage Academy or access notes via YouTube/Patreon membership.

Importance of ACLS

• Guidelines & Best Practices: Developed by practitioners worldwide and AHA (American Heart Association).
• Goal: Improve patient outcomes in life-threatening situations.
• Prerequisite: This series supplements but doesn't replace ACLS/BLS certification.

Systematic Approach to ACLS

• Primary Goals: Support oxygenation, ventilation, and circulation to preserve neurological functioning.
• Initial Assessment: Determine if the patient is conscious.
• Basic Life Support (BLS): Assess breathing and circulation together within 5-10 seconds.
  • Agonal Breathing: Not normal. Indicates cardiac arrest.
  • Chest Compressions: 100-120/minute, 2 inches deep, minimize pauses.
  • Automatic External Defibrillator (AED): Place pads, assess rhythm, and deliver a shock if needed.

Primary Assessment (ABCDE Model)

• Airway: Ensure open airway; use advanced airway if needed.
• Breathing: Provide supplemental oxygen, avoid overventilation.
• Circulation: Monitor ECG, provide appropriate drugs and fluids.
• Disability: Check neurological function (responsiveness, pupil reflex).
• Exposure: Inspect for trauma, burns, marks, etc.

Secondary Assessment

• Focus: Evaluate potential causes (H's and T's) and medical history (Sample: Signs/symptoms, Allergies, Medications, Past history, Last meal, Events leading up).

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

H's

1. Hypovolemia: Treat with fluids/blood products.
2. Hypoxia: Ensure oxygenation and ventilation.
3. Hydrogen ions (Acidosis): Ventilate for respiratory acidosis, correct metabolic acidosis with treatments like bicarbonate.
4. Hypo/Hyperkalemia: Monitor ECG changes, treat electrolyte imbalances.
5. Hypoglycemia: Administer D50.
6. Hypothermia: Warm the patient actively or passively.

T's

1. Toxins: Identify and treat with antidotes if available.
2. Tamponade (Cardiac): Relieve pressure (Pericardiocentesis).
3. Tension Pneumothorax: Decompress with needle thoracostomy.
4. Thrombus: Address coronary (MI) or pulmonary (PE) blockages.
5. Trauma: Address underlying injuries if present.

ACLS Algorithms

Cardiac Arrest Algorithm

• Rhythms: VFib, VTach, PEA, Asystole.
• Initial Response: Call for help, begin CPR, provide oxygen.
• Shockable Rhythm: Administer shock, continue CPR, provide epinephrine, and anti-arrhythmic medications.
• Non-Shockable Rhythm: Continue CPR, assess for causes (H's and T's), administer epinephrine.

Bradycardia Algorithm

• Identify unstable bradycardia: Symptoms with heart rate < 50 bpm.
• Treatment: Atropine as first line, transcutaneous pacing or dopamine/epinephrine as needed.

Tachycardia Algorithm

• Identify unstable tachycardia: Symptoms with heart rate > 150 bpm.
• Treatment: Synchronized cardioversion, or medications like adenosine for regular rhythms.

Post-Cardiac Arrest Care

• Ventilation & Oxygenation: Maintain SAT >94%, CO2 levels.
• Hemodynamic Support: Treat hypotension with fluids and vasopressors.
• Assess for MI: Perform 12 lead ECG, activate cath lab if needed.
• Temperature Management: Consider TTM for non-responsive patients.

ACS and Stroke Algorithms

Acute Coronary Syndrome (ACS)

• Assessment: Recognize MI symptoms, obtain ECG, vitals, administer medications (aspirin, nitroglycerin, morphine).
• STEMI/NSTEMI Decisions: Rapid reperfusion or adjunctive therapy based on ECG findings.

Stroke Algorithm

• Assessment: Recognize stroke symptoms (FAST: Face, Arm, Speech, Time).
• Actions: CT scan, assess for hemorrhage, consider TPA if ischemic stroke.

Conclusion: Mastering these algorithms and understanding the guidelines can significantly impact patient outcomes in critical care settings.