ACLS (4) (1).pptx
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Advance cardiac life support management in hospital services
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ACLS (4) (1).pptx
- 1. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people. ACLS management in hospital services PRESENTED BY- SAYMA KHAN NURSING OFFICER ELMCH GUIDED BY- DR.ANJALATCHI MUTHUKUMARAN NURSING SUPERINDENTENT ELMCH, LUCKNOW
- 3. INTRODUCTION..... • ACLS refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques. NC.
- 4. ACLS... • These life-threatening conditions range from dangerous arrhythmias to cardiac arrest. • ACLS algorithms frequently address at least five different aspects of peri cardiac arrest care- i. Airway management ii. Ventilation iii. CPR compressions iv. Defibrillation v. Medications
- 5. 1-AIRWAY MANAGEMENT • Maintain patient airway using the head-tilt, chin- lift. • Rescue breathing can be mouth-to- mouth breathing. • Or airway management by equipments .
- 6. .
- 7. 2-VENTILATION In the absence of an advanced airway during CPR, current guidelines based on very limited evidence recommend two positive pressure breaths after every 30 chest compression. These breaths should be of an inspiratory time of 1 s and produce a visible chest wall rise.
- 9. 3-CPR COMPRESSIONS • CPR is an emergency procedure consisting of chest compressions often combined with artificial ventilation. • Chest compressions for adults between 5cm and 6cm deep and a rate at least 100 to 120 per minute. • Chest compression to breathing ratios is set at 30 to 2 in adults
- 10. 4-DEFIBRILLATION • Defibrillation depolarize the critical mass of myocardial cell at once. • 1st paddle on the right of the chest just below the clavicle. • 2nd at precordial, region. • Paddle should be applied with pressure equivalent to 10kg. Paddle Size- Adult; 13cm Children; 8cm Infant; 4.5cm
- 13. 5-MEDICATIONS • Adrenaline(all types of cardiac arrest) 1mg every 3- 5 min. • Amidarone(VF,VT)- 1st dose:300mg IV bolus, 2nd dose 150mg. • Lidocaine (if amidarone is not available) • Sodium bicabonate(only if cardiac arrest is associated with hyperkalemia or tricyclic anti- depressent overdose) • Calcium gluconate.
- 15. ACLS TEAM.. • ACLS generally requires a team of trained individuals... i. Team leader ii. Back up leader iii. 2 CPR performer iv. An airway respiratory specialist v. An IV access and medication vi. A monitor, defibrillator or ventilator attendant D.
- 16. JOB RESPONSIBILITIES OF ACLS MEMBERS Understands and are clear about their role assignments. Are prepared to fulfill their role and responsibilities. Have working knowledge regarding algorithms. Have sufficient practice in resuscitation skills. Are committed to the success of the ACLS resuscitation.
- 17. PRTOCOLS OF CARDIAC ARREST ACC. TO ACLS • CPR Quality • Push hard (2-2.4″ (5-6 cm)) and fast (100-120 bpm) and allow chest recoil • Minimize interruptions • Do not over ventilate • If no advanced airway, 30:2 compression to ventilation ratio • Quantitative waveform capnography • If ETCO2 <10 mmHg, attempt to improve CPR quality
- 18. • Shock Energy • Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses should be considered. • Monophasic: 360 J • Return of Spontaneous Circulation • Return of pulse and blood pressure • Spontaneous arterial pressure waves with intra- arterial monitoring
- 19. • Advanced Airway • Supraglottic advanced airway or ET intubation • Waveform capnography to confirm and monitor ET tube placement • 10 breaths per minute with continuous chest compressions • Drug Therapy • Epinephrine IV/IO Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes after • Amiodarone IV/IO Dose: first dose is 300 mg bolus, second dose is 150 mg • Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg
- 20. FLOW CHART OF ACLS UNRESPONSIVE CALL FOR HELP START BLS
- 21. ATTACH MONITER & DEFIBRRILATOR WHEN AVALIABLE CHECK RHYTHM 1ST SHOCK (150-200 BIAPHASIC) CPR 30:2 (2min) 2ND SHOCK(150- 360)
- 22. CPR30:2 (2min) ADRENALINE 1MG IV EVERY 3-5 MIN 3RD SHOCK CPR 30:2 (2MIN) IF PULSE PRESENT: START POST RESUSCITATION CARE
- 23. IF PULSE NOT SEEN FURTHER SHOCK AFTER EACH 2 MIN PERIOD OF CPR. OR STILL NO PULSE SEEN AND ASYSTOLE SEEN: CONTINUE THE CPR AND SWTICH ON TO NON SHOCKABLE TREATMENT.