Basic Life Support and
Advance Cardiac Life
Support
Prepared by:
AUGUST P. MALABANAN, RN
Objectives
1. Students will be able to develop proficiency in providing
BLS care, including prioritizing chest compressions and
all the dynamics of Basic Life Support
2. Student will develop knowledge in managing cardiac
arrest until return of spontaneous circulation (ROSC),
termination of resuscitation, or transfer of care.
3. Student will be able to describe specific assessment and
management of cardiac arrest patient using AHA ACLS
Protocols
4. Student will be able to describe Post Cardiac Arrest Care
standards.
Lecture Outline
• Cardiovascular Anatomy Quick Review
• Basic Life Support
• Advanced Cardiac Life Support
–
–
–
–
Cardiopulmonary Resuscitation
Airway Management
Pharmacologic Management
Electric Therapy
• Post Cardiac Arrest Care
Anatomy Quick Review!!!
Functions of the Heart
•Pumping oxygenated blood to the other body parts.
•Pumping hormones and other vital substances to
different parts of the body.
•Receiving deoxygenated blood and carrying metabolic
waste products from the body and pumping it to
the lungs for oxygenation.
•Maintaining blood pressure.
Basic Life Support
BLS (Basic Life Support)
is a level of medical care which is used for
victims of life-threatening illnesses or injuries
until they can be given full medical care at a
hospital. It can be provided by trained medical
personnel, such as emergency medical
technicians, and by qualified bystanders.
Indication of BLS
•
•
•
•
Cardiac Arrest
Respiratory Arrest
Drowning
Choking
1
2
3
4
5
Verifying if Scene is Safe.
• Removing any potential hazard that could
impact your ability to help someone else
– Hazards could be something very obvious – traffic, downed power
lines, smoke, or fire.
– Hazards could be something small that you could miss – a wet or
slippery floor, broken glass or sharp objects.
– Hazards could also be your personal safety. It’s dark, you think you see
someone lying on the ground a distance away. Is it safe for you to go
check on them? Maybe, maybe not.
Checking for Responsiveness
First tap the victim and shout “HEY! HEY! Are
you OK?” If they do not respond, shout for help.
Activate the emergency response system. If you
are alone, retrieve an AED and other emergency
equipment. Send someone to get it if others are
available.
Assessment of Breathing and Pulse
• check for absent or abnormal breathing by watching
the chest for movements for 5 to 10 seconds.
• Simultaneously check the carotid pulse for a
minimum of 5 seconds—but no more than 10
seconds—to determine if there is a pulse present.
• It’s important to minimize delay in starting CPR, so
take no more than 10 seconds to assess the patient.
Possible Responses
• If the victim has a pulse and is breathing normally,
monitor them until emergency responders arrive.
• If the victim has a pulse but is breathing abnormally,
maintain the patient’s airway and begin rescue
breathing. Administer one breath every 5 to 6
seconds, not exceeding 10 to 12 breaths per minute.
• If no breathing and Pulse Begin CPR.
How to open Airway and Give
Rescue Breathes
• To open the airway, place 1 hand on the
casualty's forehead and gently tilt their head
back, lifting the tip of the chin using 2 fingers.
• Use the fingers of one hand to pinch the person’s
nostrils shut. This helps to prevent air from escaping
through their nose.
• Cover their mouth with yours, forming a seal so that
air doesn’t escape.
• Give rescue breaths by gently breathing into their
mouth. A rescue breath should last about 1 second.
Aim to give a rescue breath every 5 to 6 seconds.
This is about 10 to 12 breaths per minute.
• Check to see if the person’s chest rises as you
give the first rescue breath. If it doesn’t,
repeat step 2 (open the airway) before giving
additional rescue breaths.
• Continue giving rescue breaths until
emergency medical services (EMS) arrives or
the person begins breathing normally on their
own.
CPR
• Cardiopulmonary Resuscitation
• is an emergency procedure that combines chest
compressions often with artificial ventilation in an
effort to manually preserve intact brain function until
further measures are taken to restore spontaneous
blood circulation and breathing in a person who is
in cardiac arrest.
• If a pulse is not identified within 10 seconds,
immediately begin administering CPR, starting
with chest compressions. Compressions
should occur at a rate of 100 to 120
compressions per minute, with a depth of 2
inches. Use a compression-to-ventilation ratio
of 30 compressions to 2 breaths.
High Quality CPR
Push Fast : Rate of 100 compressions per minute
Push Hard: 1/3 the AP diameter of the chest or
approximately 1 ½ inches (Infants) and 2 inches in Child
Allow complete chest recoil
Minimize Interruptions
Avoid excessive ventilation
Chest
Compression
to
Ventilation
Ratio
Single Rescuer : 30
Compression is to 2
ventilation
Multiple Rescuer: 15
Compression is to 2
ventilation
If with advanced airway
every 3 seconds.
Use of AED
• is a portable electronic device that automatically
diagnoses the lifethreatening cardiac arrhythmias of ventricular
fibrillation (VF) and pulseless ventricular tachycardia
Advance Cardiac Life Support
Advance Cardiac Life Support
• often referred to by its acronym, "ACLS",
refers to a set of clinical algorithms for the
urgent treatment of cardiac
arrest, stroke, myocardial infarction (also
known as a heart attack), and other lifethreatening cardiovascular emergencies.
Components of ACLS
–
–
–
–
Cardiopulmonary Resuscitation
Airway Management
Pharmacologic Management
Electric Therapy
Airway Management
Airway Management
• Airway management in ALCS is different from
BLS as the provider use advance devices to aid
patient’s breathing
Devices
BAG VALVE MASK
LMA Insertion
Pharmacologic Management and
Electrical Therapy
Review of Meds
Epinephrine
• Classification : alpha- and beta-adrenergic agonists (sympathomimetic
agents)
Atropine Sulfate
Class : parasympatholytic, Antimuscarinic, Anticholinergic
Dopamine
Class : Inotropic Agents
Amiodarone
Class : antiarrhythmics
Atenolol
Class : Beta-Blocker
Digoxin
Class :digitalis glycosides
Lidocaine
Class : Local Anesthetic and anti
arrhythmic
Diltiazem
Class : calcium-channel blockers.
Types of Rhythm
•
•
•
•
PEA – Pulseless Electrical Activity
asystole
Bradycardia
Tachycardia
– Narrow-complex SVT
– Stable V-Tach (monomorphic or polymorphic)
PEA – Pulseless Electrical Activity
• refers to cardiac arrest in which the
electrocardiogram shows a heart rhythm that
should produce a pulse, but does not.
Pulseless electrical activity is found initially in
about 55% of people in cardiac arrest.
Management
Pharmacologic
Electric Therapy
1. Epinephrine – 1mg IV every 3-5
None
minute
2. Atropine Sulfate – 1 mg IV every 3 to 5
minutes (max dose of 0.4 mg/kg)
Asystole
Management
Pharmacologic
Electric Therapy
1. Epinephrine – 1mg IV every 3-5
None
minute
2. Atropine Sulfate – 1 mg IV every 3 to 5
minutes (max dose of 0.4 mg/kg)
3. Sodium bicarbonate 1 mEq/kg
Bradycardia
• means your heart rate is slow.
• < 60 BPM
Management
Pharmacologic
Electric Therapy
1. Atropine IV 0.5-1.0mg (Push)
2. Dopamine 5 to 20 ug/kg/min (Drip)
3. Epinephrine 2 to 10 ug/min (Drip)
1. Transcutaneous Pacing
Atrial Fibrillation and Atrial Flutter
• Atrial fibrillation is an irregular and often rapid
heart rate that can increase your risk of strokes,
heart failure and other heart-related
complications.
• Atrial flutter is similar to atrial fibrillation, a
common disorder that causes the heart to beat in
abnormal patterns.
Management
Pharmacologic
Electric Therapy
1. Adenosine 6mg Rapid IV and 12mg
Rapid IV
2. Procainamide 20-50mg/min until
arrhythmia suppressed, Hypotension,
increase of 50% in QRS Duration (max
of 17mg/kg.
3. Amiodarone – 150mg IV over 10
minutes (1 mg/min for 6 hours drip)
4. Satalol 100mg (1.5 mg/kg) over 5
minutes
Synchronized Cardioversion
Narrow Regular: 50J to 100J
Narrow Irregular: 120-200J
Wide regular : 200J
Wide Irregular : Defibrilation
Narrow Complex - SVT
• is a dysrhythmia originating at or above the
atrioventricular (AV) node and is defined by a
narrow complex
• Usually with a rate of > 150 BPM.
3 types
• Junctional Tachycardia
• Paroxysmal SVT
• Multifocal Atrial tachycardia
Sample
Pharmacologic
Electric Therapy
1. Adenosine 6mg IV then 12mg IV for 2
more doses
2. Amiodarone 150mg IV then 300mg IV
as Drip for 6 hours
3. Atenolol– 5mg IV over 5 minutes
4. Digoxin – 0.25 mg IV (max of
1mg/day)
5. Diltiazem - 0.25 mg/kg IV
None
Pulseless V-tach and V-Fib
• Ventricular tachycardia (VT or V-tach) is a type of abnormal
heart rhythm, or arrhythmia. It occurs when the lower
chamber of the heart beats too fast to pump well and the
body doesn't receive enough oxygenated blood.
• Ventricular fibrillation is a type of abnormal heart rhythm
(arrhythmia). During ventricular fibrillation, disorganized
heart signals cause the lower heart chambers (ventricles) to
twitch (quiver) uselessly. As a result, the heart doesn't pump
blood to the rest of the body.
Pharmacologic
Electric Therapy
1. Amiodarone – 300mg IV once then
Defibrilation – Start at 120J or 200J max
150mg for succeeding dose
of 360J using Biphasic Defibrilator (200 to
2. Epinephrine 1mg IV every 3 to 5
360 J using Monophasic Defib)
minutes
3. Lidocaine – 1mg to 1.5mg/kg, then
0.5 to .75mg/kg IV/IO (max of 3
doses)
4. Magnesium- loading dose of 1 to 2 mg
for Torsades de pointes
Post Cardiac Arrest Care
Post cardiac Arrest Care when there is defined
ROSC or Return of Spontaneous Circulation
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
1. Targeted Temperature Management
• For protection of the brain and other organs, hypothermia is a
helpful therapeutic approach in patients who remain
comatose (usually defined as a lack of meaningful response to
verbal commands) after ROSC.
• 32°C to 34°C for 12 or 24 hours beginning minutes to hours
after ROSC.
• Can be done thru superficial cooling or core temperature
control
• Possible Problems
– Coagulopathy
– Arrhythmias
– and hyperglycemia
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
Organ-Specific Evaluation and Support
• Pulmonary System
• Sedation After Cardiac Arrest
• Cardiovascular System
Organ-Specific Evaluation and Support
• Pulmonary System
• Sedation After Cardiac Arrest
• Cardiovascular System
Pulmonary System
• Essential diagnostic tests in intubated patients
include a chest radiograph and arterial blood gas
measurements.
• Evaluation of a chest radiograph should verify the
correct position of the endotracheal tube and the
distribution of pulmonary infiltrates or edema and
identify complications from chest compressions
• Providers should adjust mechanical ventilator
support based on the measured
oxyhemoglobin saturation, blood gas values,
minute ventilation (respiratory rate and tidal
volume), and patient-ventilator synchrony.
• ABG
•
•
•
•
Maintain a 94% O2 Saturation
Adjustment of O2 support
No over ventilation
RR of 12 to 20, ETCO2 of 35 to 45 mmhg
Organ-Specific Evaluation and Support
• Pulmonary System
• Sedation After Cardiac Arrest
• Cardiovascular System
Sedation After Cardiac Arrest
• Patients with coma or respiratory dysfunction after
ROSC are routinely intubated and maintained on
mechanical ventilation for a period of time, which
results in discomfort, pain, and anxiety.
• Shorter-acting medications that can be used as a
single bolus or continuous infusion are usually
preferred.
Organ-Specific Evaluation and Support
• Pulmonary System
• Sedation After Cardiac Arrest
• Cardiovascular System
Cardiovascular System
• The clinician should evaluate the patient's 12lead ECG and cardiac markers after ROSC
• Used of PCI (Percutaneous Coronary
Intervention)
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
Vasoactive Drugs for Use in Post–Cardiac Arrest
Patients
Vasoactive drugs may be administered after ROSC to
support cardiac output, especially blood flow to the
heart and brain. Drugs may be selected to improve
heart rate (chronotropic effects), myocardial
contractility (inotropic effects), or arterial pressure
(vasoconstrictive effects), or to reduce afterload
(vasodilator effects).
Do not mix vasoactive agents with
NaHCo3
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
Modifying Outcomes From Critical Illness
• Glucose Control
• Steroids
• Hemofiltration
Glucose Control
Strategies to target moderate glycemic control (144 to
180 mg/dL [8 to 10 mmol/L]) may be considered in
adult patients with ROSC after cardiac arrest. Attempts
to control glucose concentration within a lower range
(80 to 110 mg/dL [4.4 to 6.1 mmol/L]) should not be
implemented after cardiac arrest due to the increased
risk of hypoglycemia
Steroids
• Corticosteroids have an essential role in the
physiological response to severe stress,
including maintenance of vascular tone and
capillary permeability.
Hemofiltration.
• Hemofiltration has been proposed as a
method to modify the humoral response to
the ischemic-reperfusion injury that occurs
after cardiac arrest.
IDENTIFY REVERSIBLE CAUSES
1.
2.
3.
4.
5.
Targeted Temperature Management
Organ-Specific Evaluation and Support
Vasoactive Drugs for Use in Post–Cardiac Arrest Patients
Modifying Outcomes From Critical Illness
Central Nervous System
Central Nervous System
• The pathophysiology of post–cardiac arrest
brain injury involves a complex cascade of
molecular events that are triggered by
ischemia and reperfusion and then executed
over hours to days after ROSC
• Clinical manifestations of post–cardiac arrest
brain injury include coma, seizures,
myoclonus, various degrees of neurocognitive
dysfunction (ranging from memory deficits to
persistent vegetative state), and brain death.
• Seizure Management
• Neuroprotective Drugs
Seizure Management
• An EEG for the diagnosis of seizure should be performed with
prompt interpretation as soon as possible and should be
monitored frequently or continuously in comatose patients
after ROSC
• Use of anti-seizure drugs such as thiopental, diazepam.
Neuroprotective Drugs
• Lamotrigine
• Citicholine
• Magnessium Sulfate
TAKE HOME
•
•
•
•
On recognition of a cardiac arrest event, a layperson should simultaneously and
promptly activate the emergency response system and initiate cardiopulmonary
resuscitation (CPR).
Performance of high-quality CPR includes adequate compression depth and rate
while minimizing pauses in compressions
Early defibrillation with concurrent high-quality CPR is critical to survival when
sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular
tachycardia.
Administration of epinephrine with concurrent high-quality CPR improves survival,
particularly in patients with nonshockable rhythms.
•
•
•
Recognition that all cardiac arrest events are not identical is critical for optimal
patient outcome, and specialized management is necessary for many conditions
Post–cardiac arrest care is a critical component of the Chain of Survival and
demands a comprehensive, structured, multidisciplinary system that requires
consistent implementation for optimal patient outcomes.
Prompt initiation of targeted temperature management is necessary for all
patients who do not follow commands after return of spontaneous circulation to
ensure optimal functional and neurological outcome.
References
• https://www.ahajournals.org/doi/full/10.1161
/circulationaha.110.971002
• https://coastalcpr.com/scene-safety/
• https://resources.acls.com/free-resources/blsalgorithms/adult-cardiac-arrest
• https://www.healthline.com/health/rescuebreathing#for-child-or-infant