How to Pass the Advanced Cardiac Life Support (ACLS) Like A Boss in 2021

The Advanced Cardiac Life Support Certification (ACLS) can be very stressful whether you are taking the examination for the first time or renewing every 2 years. Here are some helpful tips in passing the ACLS Certification Examination.

ADVANCED CARDIOVASCULAR LIFE SUPPORT REVIEW

Understanding Basic Life Support

Check for responsiveness of the patient
- If no response, assess the environment for safety before beginning cardiopulmonary resuscitation
Shout for help. Activate the emergency response system. Have another person obtain the AED/Defibrillator.
- If a mobile device is available, activate emergency response system yourself immediately (2020 AHA Guidelines Update)
Check for Breathing and Pulse. NO MORE THAN 10 SECONDS.
Begin CPR if no pulse is detected.
If pulse is present, start rescue breathing immediately.

Chest compressions are 100 to 120 compressions per minute.

Rescue breaths are 1 breath every 6 seconds with or without an advanced airway (2020 AHA Guidelines Update).

Advanced Life Support Mega Code and Examination

ACLS Primary Survey (ABCDE)

Airway
- Maintain airway patency in unconscious patients
- Use advanced airway if needed
- Confirm CPR/Ventilation/Secure Device
- Monitor Airway Placement with continuous quantitative waveform capnography
Breathing
- Give supplementary oxygen as needed
  - 100% oxygen for cardiac arrest patients
  - Titrate oxygen for stable patients
- Avoid excessive ventilations
- IMPORTANT: AGONAL GASPS ARE NOT NORMAL (FIRST SIGNS OF IMPENDING CARDIAC ARREST). START CPR IMMEDIATELY.
Circulation
- Monitor CPR quality
  - Minimize interruptions and checking pulse no more than 10 seconds
  - If person performing CPR starts to provide ineffective chest compressions: Give constructive feedback
- Attach Monitor/Defibrillator/AED
  - First Step to using AED is turning on the device. Then follow the prompts.
- Obtain IV/IO Access
  - Give Appropriate medications
  - Administer IV/IO fluids
  - IMPORTANT NOTE: IV ACCESS IF PREFERRED OVER IO ACCESS, UNLESS IV FAILS (2020 AHA Guidelines Update)
- Check glucose levels/temperature/ capillary refill
- IMPORTANT: BLOOD PRESSURE MINIMUM IS 90 mmHg
Disability
- Check for neurological function
- Quickly assess for responsiveness (LOC, Pupil Dilation)
- AVPU
  - Alert
  - Verbal stimulation
  - Painful stimulation
  - Unresponsive
- Exposure
  - Remove clothing: Assess for obvious signs of trauma, bleeding, burns, markings, medical alert bracelet

Secondary Assessment Survey (SAMPLE Mnemonic)

Signs and Symptoms
- Objective information from family or ambulance
Allergies
- Allergic to food, medications, environmental allergies
Medications
- Over the counter medications
- Vitamins
- Supplements
- Prescribed Medications
- Any medications not prescribed that may have been ingested or used
Past Medical History
- Previous illnesses
- Previous hospitalizations
Last Meal/Liquids Consumed
- What and when was the last meal/fluid intake?
Events
- What lead up to the current presentation?

Secondary Assessment H’s and T’s

Hypovolemia
Hypoxia
Hydrogen Ion
Hypo/Hyper Kalemia
Hypothermia

Tension Pnuemothorax
Tamponade
Toxins
Thrombosis (Pulmonary)
Thrombosis (Coronary)

Advanced Life Support Cardiac Rhythms

Ventricular Fibrillation/Pulseless Ventricular Tachycardia

Shockable Rhythm: Yes
First Line Medication: Epinephrine 1mg every 3 to 5 minutes
Second Line Medication: Amiodarone IV/IO dose 300mg bolus then 150mg second dose
Lidocaine IV/IO Dose – First Dose: 1 – 1.5 mg/kg and Second Dose: 0.5 – 0.75 mg/kg
- IMPORTANT NOTE: Both Amiodarone and Lidocaine are acceptable second line medication obtains (2020 AHA Guidelines Update)

Asystole/Pulseless Electrical Activity

Shockable Rhythm: No
First Line Medication: Epinephrine 1mg every 3 to 5 minutes
- IMPORTANT NOTE: Epinephrine should be given ASAP. Do not wait for 2 minutes of compressions to give epinephrine (2020 AHA Guidelines Update)

Bradycardia

Stable Patient: Monitor and Observe
Unstable Patient: We Treat Immediately
- First Line Treatment: Transcutaneous pacing and/or
- First Line Medication: Atropine IV 1mg bolus every 3-5 minutes
  - Maximum dose of 3mg
  - First and subsequently doses of Atropine start with 1 mg (2020 AHA Guidelines Update)
- Dopamine IV Infusion
  - 5-20 mcq/kg per minute
    - Dopamine dosing starts at 5 mcg/kg/min instead of 2 (2020 AHA Guidelines Update)

Tachycardia Considerations >150/min

Stable Patients
- 12 Lead EKG on all stable patients
- Vagal Maneuvers
- Adenosine: First Dose – 6mg rapid IV push and Second Dose – 12mg
Unstable Patients
- First Line Treatment: Synchronized cardioversion
- Regular Narrow Complex, consider giving adenosine
Torsades de pointes give magnesium sulfate

Post Cardiac Arrest/Return of Spontaneous Circulation (ROSC)

Manage airway with early placement of endotracheal tube
Maintain respiratory parameters
- 10 breaths/min
- SpO2 (oxygen saturation) >92%
- PaCO2 35 – 45 mmHg
Treat hypotension
- Systolic blood pressure > 90 mmHg
- Mean Arterial Pressure > 65 mmHg
12 Lead EKG
Start temperature therapy immediately and continue rechecking therapy effectiveness every 24 hours if the patient is unable to follow commands post resuscitation

Dynamic Team Roles

If a person is given an assignment outside of their scope of practice or are not knowledgeable, it is the person’s responsibility to ask for another role. ASK FOR ANOTHER ASSIGNMENT DO NOT REASSIGN ROLE.
Closed Loop Communication: Repeat what the person has called and advise once something is completed