Overview off BLS & ACLS

ApichayaMonsomboon, MD.
ApichayaMonsomboon,
p
of Emergency
g
y medicine
Department
Siriraj Hospital

Course: First day

Lecture
Basic life support (BLS):
(BLS): Adult & pediatric
Advanced cardiac life support (ACLS)
ECG recognition & Algorithm
Practice
Advanced airway management
Pediatric BLS
One two rescuer CPR
Electrical therapy & AED
Al i h
Algorithm
Exam

BLS

Course: Second day

L t
Lecture
Stroke
Acute coronary syndrome
Practice
P ctice
Mega code
Exam
Mega code
Written exam BLS & ACLS

Overview
Adult and Pediatric BLS 2010
CA-B
Automated external defibrillator (AED)

ACLS 2010
Post cardiac arrest care

CPR Guideline
Newborn

Neonatal resuscitation

Infant: < 1 year

Pediatric Advanced Life Support

Childhood: 1 yearyear-puberty

B
d
l
/axillary
ill
h i
Breast
development/
development/axillary
hair

Ad lt
Adult

Advanced Cardiac Life Support

Earlyrecognized
y
g
EarlyCPR
&Activation

Immediate
defibrillation

Effective
ACLS

PostCPR

Valenzuela TD, et al. Circulation 1997; 96[10]:33083313

CPR before Defibrillation

Cerebral cortex
3 - 4 min

Cerebellum
10 - 15 min

Medulla
(respiratory center)
10 - 15 min
i

Basiclife support

Adult BLS Healthcare Providers

E l
Earlyrecognition&Activation
i i &A i i

Checkresponsiveness
Activate
ActivateEmergencyresponse
system
y

Callfordefibrillator

Checkforsignsofcirculation
Pulsedetection10sec

High--Quality CPR
High
Rate at least 100
100/min
/min
Compression depth at least 2 inches ((5
5 cm)
Allow complete chest recoil after each
compression
Minimize interruptions in chest
compressions
Avoid excessive ventilation

Chest compression

Open Airway
Headtiltchinlift

Jaw thrust

Breathing
Give
Gi 2 slow
l
breaths,
b
h each
h breath
b
h for
f 1 sec
Allow exhalation between breaths

Automated external defibrillator

Use AED suddenly when it arrive

1) Open
2) Attach
Att h adhesive
dh i padthen
dth plug
l in
i
donttouchthepatient
3) Analyze
Analyze
don
ttouchthepatient
4) Shock
5) Immediatelychestcompression

Pediatrics
P di t i

Basic algorithm
g

Pulse check

Usebrachialpulse< 1year

Carotidpulseforchild

High--Quality CPR
High
Rate at least 100
100/min
/min
Depth at least 1/3 AP diameter
(4 cm.
cm for infant
infant, 5 cm for children)
Complete recoil
Minimize interruptions
Avoid excessive ventilation

Chest compression

Belownipplelineininfant
pp

Chest compression

Lowerhalfofsternuminchild

Chest compression
Rotate
R
compressor every 2 minutes
i
Switch time < 5 seconds
Lone rescuer = 30
30:: 2,2 rescuers = 15
15:: 2
Prefer chest compression + ventilation
>compression only

Bag&maskventilation:ECclamp

Give2breathschestmove

child<
child<8
AEDped
ped
dose
hild 8years
years
AED
d doseattenuator
d
attenuator
Infant
Infant
Manualdefibrillator

Etiology
Eti
l
off arrest:
arrestt:
Respiratory
Cardiac arrhythmia
Pulse
P
lse check
Brachial (<
(< 1 year)
Carotid
Chest compression
Position
Technique

Adult

CPRsequence

C A B

Compressionrate

p
Compressionto
VentilationRatio
(untiladvanced
airwayplaced)
Ventilationswith
advancedairway
(HCP)
Defibrillation

Infant

Unresponsive
NobreathingorOnlygasping

Recognition
g

Compressiondepth
p
p

Children

Atleastrate100/min
Atleast2
i h ( )
inches(5cm)

30:2
(1or2rescuers)

Atleast1/3AP
Depth
Ab t i h
About2inches
(5cm)

Atleast1/3AP
Depth
Ab t i h
About1inches
(4cm)

30:2forSingleRescuer
15:2for2HCPRescuers

1breathevery68seconds(810breaths/min)
Asynchronouswithchestcompressions
About1secondperbreath
VisibleChestRise
AttachanduseAEDassoonasavailable.
Mi i i i
Minimizeinterruptionsinchestcompressionsbeforeandafter
i
i h
i
b f d f
shock,resumeCPRbeginningwithcompressions
immediatelyaftereachshock

ACLS
Team role
Circulation:
High quality CPR Monitoring
ECG recognition and algorithm
Electrical therapy
Drug
Airway:
y Advanced airway
y
Breathing: Provide ventilation
Differential diagnosis:
diagnosis:Cause and sequence

High quality CPR

Push hard (>
(> 2 inches) and fast ((>
> 100
100/min)
/min) and fully
recoil
Minimize interruptions in compression
Avoid excessive ventilation
Rotate compressor every 2 minutes
30 : 2, If no advanced airway

Quantitative waveform capnography (>10

mmHg)
Intra--arterial pressure (>20 mmHg)
Intra

Capnography
p g p y

IfPETCO2<10mmHg improvequalityCPR

ECG recognition and algorithm

Recognition and
access patient
No
Pulse

CPR

No

Shokable
rhythm

Asystole/PEA
y

Yes

Tachycardia/
Bradycardia
d
di

Yes

VF/pulseless
p
VT

Electrical therapy

Pediatricpaddlefor<1yearor<10kg

D
Drug
Th
Therapy
Epinephrine
Amiodarone
Tracheal
T
h l route
t is
i nott recommended
d d
Unpredictable blood level
IOaccess

Airway adjuncts
Oropharyngeal airway
N
Nasopharyngeal
h
l airway
i
Laryngeal mask airway (LMA)
Esophageal
Esophagealp g -Tracheal Combitube
Endotracheal tube
Transtracheal (Translaryngeal catheter
ventilation)

LMA
A

Combitube

Invasive airway and ventilation control

Percutaneouscricothyrotomy (Transtracheal
catheter Ventilation)
Surgical
g
Cricothyrotomy
y
y
Tracheostomy

Treatable causeof cardiac arrest

Ts

Hs
H
Hypoxia
i

T i
Toxin

Hypovolemia

Tamponade (cardiac)

Hydrogen ion (Acidosis)

Tension pnumothorax

Hypo--/hyperkalemia
Hypo

Thrombosis, pulmonary

Hypothermia
yp

Thrombosis, coronary

Post
P cardiac
di arrest
care

Postcardiac arrest care

M it BP,
Monitor:
BP, ECG
Ventilation 10 12 breath/min
Keep PETCO2 35 40 mmHg
Keep O2sat > 94 %,
% BS < 180 mg/dl
Treat hypotension (IV Fluid, Inotropic drug)
Consider therapeutic hypothermia
Consider coronary reperfusion
Treat reversible cause

Question