ACLS Overview and Assessment

Overview

This lecture introduces the systematic approach to Advanced Cardiac Life Support (ACLS), focusing on initial assessment, Basic Life Support (BLS), and the primary and secondary assessment models for managing critical cardiac emergencies.

Introduction to ACLS

• ACLS involves standardized guidelines and algorithms developed to improve patient outcomes in life-threatening cardiac events.
• The American Heart Association (AHA) provides these peer-reviewed protocols for critical care practitioners.
• Knowing and applying ACLS guidelines is essential for ICU staff to respond effectively to patient deterioration.

Systematic Approach Overview

• Begin with an initial impression: assess the patient’s location, appearance, and monitor readings.
• Determine if the patient is conscious or unconscious to direct the next steps.
• If unconscious, immediately alert emergency response and start the BLS assessment.

Basic Life Support (BLS) Assessment

• Simultaneously assess breathing and circulation by checking for normal breathing and a carotid pulse (5–10 seconds).
• Agonal breathing is abnormal and suggests cardiac arrest.
• If there is a pulse but no breathing, provide 1 breath every 5–6 seconds with a bag-valve mask.
• If no pulse, immediately start chest compressions at 100–120 per minute, 2 inches deep, with full recoil, minimizing interruptions.
• Attach AED/defibrillator as soon as possible and assess for a shockable rhythm.

Primary Assessment (ABCDE Model)

• A: Airway – Maintain airway using head tilt/chin lift or adjuncts; intubate if necessary and confirm placement.
• B: Breathing – Provide supplemental oxygen; use 100% FiO2 in codes and monitor with capnography and SpO2.
• C: Circulation – Ensure effective compressions; obtain IV/IO access; monitor ECG and treat arrhythmias; check for return of spontaneous circulation (ROSC).
• D: Disability – Assess neurological status with AVPU scale and check pupillary response.
• E: Exposure – Fully expose and inspect the patient for trauma, bleeding, burns, or medical alert bracelets.

Secondary Assessment

• Identify causes of emergency and gather focused medical history using SAMPLE (Signs/Symptoms, Allergies, Medications, Past history, Last meal, Events).
• Consider reversible causes of cardiac arrest (Hs and Ts).
• Early recognition and reversal of underlying causes support better outcomes.

Key Terms & Definitions

• ACLS (Advanced Cardiac Life Support) — Set of clinical protocols for managing severe cardiovascular emergencies.
• BLS (Basic Life Support) — Fundamental steps for supporting airway, breathing, and circulation.
• ROSC (Return of Spontaneous Circulation) — Restoration of a pulse and effective blood flow after cardiac arrest.
• Agonal Breathing — Gasping, abnormal breaths often seen after cardiac arrest.
• AVPU Scale — Neurological assessment: Alert, responds to Voice, responds to Pain, Unresponsive.
• ABCDE Model — Systematic approach: Airway, Breathing, Circulation, Disability, Exposure.

Action Items / Next Steps

• Review and memorize the ABCDE and SAMPLE assessment models.
• Practice BLS skills, including effective compressions and use of a defibrillator.
• Prepare for future lessons covering specific ACLS algorithms and interventions.