ACLS or Advanced Cardiac Life Support is a set of clinical guidelines that are used to treat cardiac arrest and other life-threatening medical emergencies.
One of the most complex ACLS algorithms providers will encounter is cardiac arrest. We will cover both shockable and unshockable rhythms.
In this blog post, we will discuss the most effective strategies for managing cardiac arrest using the ACLS megacode.
The following is a scenario in which you would use the out-of-hospital adult cardiac arrest megacode:
You are working as a paramedic responding to an altered mental status call. Upon arrival, you hear a person screaming loudly attempting to wake up a middle-aged man.
Demonstrate what you would do next upon arrival
The person is a 60-year-old male lying down on the floor in the living room of their home. He is agonal breathing and not responsive.
Airway: The airway is patent but agonal breathing 3 breaths per minute is noted upon assessment. The flow through the trachea is not impaired.
Breathing: Oxygenation is showing 60% on room air. You provide oxygen via a bag valve mask.
Circulation: Blood pressure is 60/40, heart rate is not being captured on the monitor, the rhythm check is not being captured on the monitor, and the pulse is present but very weak.
Disability: The man is responsive to painful stimuli only.
Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet. The man’s wife states he had been burping more than normal and was complaining of indigestion.
What are your next actions?
What are your next actions?
Pulse and breathing are no longer present so we will begin CPR starting with compressions.
Perform High-Quality Compressions
Give 2 breaths with a barrier device
You will need to perform one to two rounds of high-quality CPR.
The AED does not advise a shock. This means the man is either in asystole or pulseless electrical activity.
What are your next steps?
Resume CPR immediately!
What interventions could you perform next?
It is important to consider your H’s and T’s for these rhythms and treat accordingly.
H’s and T’s are mnemonics for the major causes of arrest:
Two attempts at delivering a shock were not advised. The man received 3 doses of epinephrine. Upon the third attempt, a deliverable shock was advised.
The team continued high-quality chest compressions and ROSC was achieved.
You will begin the transfer to the nearest hospital. Your scenario has concluded.
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