INTRODUCTION

What is
ACLS ?

Objectives
Management of the first 10
minutes of witnessed, adult, VF
cardiac arrest.
The management of the 9 core
clinical cases

The ACLS cases

Cardiorespiratory
arrest
Witnessed VF /
VT
Refractory VF
PEA
Asystole

Acute
myocardial
infarction
Unstable
tachycardia
Stable
tachycardia
Bradycardia

Knowledge and
Skill
Airway management and endotracheal
intubation
Recognition and therapy of the major
ACLS emergency conditions
Electrical therapy
I.V. and invasive therapeutic
Lethal and non-lethal arrhythmias
ACLS cardiovascular pharmacology

Chain of Survival

Basic Steps
PRIMARY ABCD SURVEY
Airway
Breathing

Open the airway

Provide positive-pressure
ventilations
Circulation Give chest compressions
Defibrillatio Shock VF / pulseless VT
n

Basic Steps
SECONDARY ABCD SURVEY
Airway

Provide advanced airway management

(tracheal intubation, laryngeal mask airway,
combitube)

Breathing

Confirm proper tube placement by primary

(physical exam) and secondary (exhaled
CO2 and esophageal detector device)
methods, check for adequate oxygenation
and ventilation

Circulation

Obtain IV access, determine rhythm, give

medications appropriate for rhythm and
vital signs

Differential

Search for, find, and treat reversible causes

TUJUAN UTAMA ACLS

1. Membuat sirkulasi spontan dengan
tekanan darah yang adekuat
2. Mengoptimalkan fungsi jantung
3. Menekan dan mencegah aritmia yang
bermakna
4. Menghilangkan sakit
5. Mengoreksi asidosis
6. Mengobati gagal jantung kongestif

FARMAKOLOGI
Oxygen
Epinephrine
Atropine
Lidocaine
Adenosine
Verapamil
Amiodarone
Aspirin

Vasopressin
Sodium bicarbonate
Dopamine
Dobutamine
Digitalis
Morphine
Nitroglycerine
Thrombolytic

Skill Station : ELECTRICAL THERAPY

Skill Station : ARRHYTHMIA RECOGNITION

Skill Station :
AIRWAY MANAGEMENT

Skill Station : BASIC LIFE SUPPORT

Team MEGACODE

SELESAI

UNIVERSAL
ALGORITHM

(A) Assess Responsiveness

Responsive
observe
treat as
indicated

Not Responsive
activate EMS
call for defibrillator
(A) assess breathing
(open the airway,
look, listen, and
feel)
Breathing
place in recovery
position

Not Breathing
(B) give 2 slow
breath
(C) check pulse

No Pulse

Rescue
breathing
Oxygen
IV
Vital sign

Endotracheal
intubation
History
Physical examination
Monitor, 12 leads

Start CPR (C)

Suspected
Cause

Ventricular fibrillation / tachycardia (VF / VT)

Present on monitor / defibrillator?

Hypotension/shock/
acute pulmonary
edema
Go to Fig 8
Acute MI
Go to Fig 9
Arrhythmia
Too Slow
Go to Fig
5

Too Fast
Go to Fig
6

Intubate
Confirm tube
placement; consider
end-tidal CO2 indicator
Confirm ventilation
Determine rhythm &
cause

VF / VT
Go to Fig
2

Electrical activity
No

Yes

Pulseless
electrical activity
(PEA)
Go to Fig 3

Asystole
Go to Fig 4

 Person collapses
Possible cardiac
arrest
unresponsiveness
Assess
responsiveness
Begin
Primary ABCD Survey
(begin BLS algorithm)
Activate emergency response
system
Call for defibrillator
A assess breathing (open
airway: look, listen & feel)
Not breathing

Give 2 slow breaths

Assess pulse, if no pulse

Start chest compressions

C
D

Attach monitor / defibrillator when

available No pulse
CPR continues
Assess rhythm

 CPR continues
Assess rhythm
VF / VT
Attempt defibrillation
(up to 3 shocks if VF/VT persists)

CPR for
1
minute

Non VF / VT
Non VF/VT
(asystole or PEA)

Secondary ABCD survey

Airway: attempt to place airway device
Breathing: confirm and secure airway device,
ventilation, oxygenation
Circulation: gain intravenous access; give
adrenergic agent; consider antiarrhytmics,
buffer agents, pacing
Non VF/VT patients:
Epinephrine 1 mg VI, repeat every 3-5 minutes
VF/VT patients:
Vasopressin 40 U IV, single dose, 1 time only
or
Epinephrine 1 mg IV, repeat every 3-5 minutes
(if no response after single dose of vasopressin,
may resume epinephrine 1 mg IV push; repeat
every 3-5 minutes)

CPR up
to
3
minute

SELESAI