How to Pass the Advanced Cardiac Life Support (ACLS)

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.

Understanding Basic Life Support

1. Check for responsiveness of the patient
2. Shout for help. Activate the emergency response system. Obtain the AED/Defibrillator.
3. Check for Breathing and Pulse. NO MORE THAN 10 SECONDS.
4. Begin CPR if no pulse is detected.
5. If pulse is present, start rescue breathing immediately.

Chest compressions are 100 to 120 compressions per minute.

Rescue breaths are 1 breath every 5 to 6 seconds.

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
  • 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

Asystole/Pulseless Electrical Activity

• Shockable Rhythm: No
• First Line Medication: Epinephrine 1mg every 3 to 5 minutes

Bradycardia

• Stable Patient: Monitor and Observe
• Unstable Patient: We Treat Immediately
  • First Line Medication: Atropine IV 0.5mg bolus every 3-5 minutes
    • Maximum dose of 3mg
  • Dopamine IV Infusion
    • 2-20 mcq/kg per minute

Tachycardia Considerations >150/min

• Stable Patients
  • 12 Lead EKG on all stable patients
  • Vagal Maneuvers
  • Adenosine 6mg rapid IV push
• Unstable Patients
  • Synchronized cardioversion
  • Regular Narrow Complex, consider giving adenosine
• Torsades de pointes give magnesium sulfate

 

Post Cardiac Arrest/Return of Spontaneous Circulation (ROSC)

1. Maintain oxygen saturation >94%
2. Treat hypotension (SBP <90 mmHg)
3. 12 Lead EKG
4. Start temperature therapy immediately and continue rechecking therapy effectiveness every 24 hours

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 

Stroke Guidelines

• Give Fibrinolytic Therapy immediately as long as no contraindication
• CT Scan with no contrast immediately