ACLS

(Advanced Cardiac Life Support)

Oleh : M. Samsul Arifin Nur Hidayati Azar Peppy Tria Tita Luthfia S 0810710072 0810710088 0810710092 0810710107

Pembimbing : dr. Ali Haedar, SpEM

FK UNIV. BRAWIJAYA/RSU DR. SAIFUL ANWAR MALANG 2013

Introduction
Cardiopulmonary arrest results in a rapid decline in oxygen delivery to the brain Permanent disability or death results if the period of cerebral hypoxia lasts longer than 3 minutes

Introduction
Cardiopulmonary resuscitation (CPR) is the term used to describe the maintenance of adequate breathing and circulation in a patient who cannot do so for him- or herself The aim of CPR is to restore respiration and adequate cardiac output as soon as possible to prevent death or permanent disability

Chain of Survival
1. Immediate recognition of cardiac arrest and activation of the emergency response system 2. Early CPR with an emphasis on chest compressions 3. Rapid defibrillation 4. Effective advanced life support 5. Integrated post-cardiac arrest care Basic Life Support

1. Immediate Recognition & Activation EMS

Ensure that the scene is safe Check for response (tapping and shouting) and any abnormal breathing Activate EMS Information: location, events, number, condition, aid Follow any instruction from dispatcher and hang up only when instructed Lay rescuer should not check for pulse (assume cardiac arrest if unresponsive victim is not breathing normally) Healthcare provider should take <10s to check for pulse

2. Early CPR
Chest compression (forceful rhythmic applications of pressure over the lower half of sternum) Place heel of the hand in lower half of sternum Adult sternum should be depressed at least 2 inches/5cm Allow chest recoil after every compression Minimizing interruptions in compression Avoiding excessive ventilation Give at least 100 compression/minute Deliver each rescue breath over 1 second (mouth to mouth or mouth to mask) Compression : ventilation = 30:2

3. Early Defibrillation with AED

Retrieve an AED/ Automated External Defibrillator (if nearby & easily accessible) Attach and turn the AED on Follow the AED prompts Resume chest compression immediately after the shock

4. Advanced cardiovascular life support (ACLS)

Interventions: Prevent cardiac arrest, Treat cardiac arrest, Improve outcomes of patient who achieve return of spontaneous circulation (ROSC) after cardiac arrest
ACLS interventions build on the BLS foundation to further increase the likelihood of ROSC with: Drug therapy, Advanced airway management, Physiologic monitoring

Survival and neurological outcome can be improved with integrated post cardiac arrest care
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Drugs Therapy
Epinephrine (1:10,000) - (drug class= Vasopressor) 1 mg Rapid IV/IO push 1st for all pulseless arrests Vasopressin (drug class= Vasopressor) 40 Units IV/IO- can replace 1st or 2nd Epi Amiodarone Used with ventricular rhythms (V-Fib / V-Tach) Pulseless= 300 mg IV push or drip over 10 min With pulse= 150 mg in 100 ml D5W drip over 10 min Amiodarone Maintenance Drip= 450mg in 250 glass bottle of D5w Drip infusion @ 1mg/min

Drugs Therapy
Atropine 0.5mg IV/IOfor sinus bradycardia may repeat every 5 minutes for Max of 3 mg Adenosine Used for SVT or stable monomorphic VT 6mg rapidlymay repeat with a 12mg x 2- always follow with NS bolus & give closest to heart Warn patient and family about drug related symptoms: Chest pressure, feeling faint, EKG pause

Drugs Therapy
Dopamine Drip Chronotropic drug- given for Symptomatic Bradycardia refractory to Atropine 2-10 mcg/kg/min Epinephrine Drip 2-10 mcg/min For symptomatic bradycardia refractory to Atropine

Advanced Airway

ACLS 2010 Guideline Review

Basic Life Support (BLS) Cardiac Arrest Bradycardia Tachycardia Acute Coronary Syndrome

5. Post Cardiac Arrest Care

Objectives : Optimize cardiopulmonary function and vital organ perfusion Transport patient to appropriate hospital with comprehensive post-cardiac arrest treatment system (acute coronary intervention, neurological care, goal directed critical care, and hypothermia) Transport the in-hospital post cardiac arrest patient to appropriate critical care unit capable of providing comprehensive post cardiac arrest care Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest

5. Post Cardiac Arrest Care

Subsequent Objectives : Control body temperature to optimize survival and neurological recovery Identify and treat acute coronary syndrome Optimize mechanical ventilation to minimize acute lung injury Reduce the risk of multiorgan injury and support organ function if required Objectively assess prognosis for recovery Assist survivor with rehabilitation services when required

Multiple System Approach to Post Cardiac Arrest Care

Ventilation: capnography; CXR; pulse oxymetry; BGA; mechanical ventilation Hemodynamic: frequent blood pressure monitoring; arterial line; treat hypotension Cardiovascular: continuous cardiac monitoring; 12-lead ECG; cardiac marker assessment; treat ACS; echocardiogram; treat myocardial stunning Neurological: serial neurological exam; EEG monitoring; core temperature measurement; non-enhanced CT scan Metabolic: serial lactate exam; serum potassium exam; urine output; serum creatinine; serum glucose; avoid hypotonic fluid