Advance Cardiac Life Support (ACLS)

Advance cardic life support (ACLS) includes the use of advanced airway managment, detirillation, and drugs along with the effictive performance of basic CPR. Most cardiac arrests are due to ventricular fibrillation and are unwitnessed.


Patient Managment ACLS Protocols (Adults)

Unwitnessed Cardiac Arrest

This is the basic protocol for an adult with an unwitnessed cardiac arrest (with ventricular fibrillation or pulseless ventricular tachycardia):

* Check for pulse, if adsent, continue as below.
* Perform basic CPR untill a defibrillator is available. When available, apply paste or conductive pads (one at the right upper sternum and one at the left axillary line). Place the paddles as directed on the handles.
* Check rhythm. If monitor shows ventricular fibrillation or pulseless ventricular tachycardia, continue.
* Defibrillate at 200 joules. If no conversion, continue.
* Defibrillate at 200-300 joules. If no conversion, continue.
* Defibrillate at full output (360 joules).
* Continue CPR if pulse is absent on recheck.
* Establish IV line and intubate if possible.
* Give epinephrine 1 mg every 3-5 minutes.
* 30-60 seconds after epinephrine administration, defibrillate with 360 joules (or 'stack' of 3 defibrillatins). If there is no conversion continue. If VF or VT persists, the prognosis for successful recovery is dismal. A variety of drugs are recommended at this point.
* Give lidocaine 1-1.5 mg/kg by IV push, and wait 30-60 seconds before repeating defibrillation.
*  Defibrillate with 360 joules. If no conversion, continue.
* Repeat Lidocaine at 0.5mg/kg IV push. (May give up to 3.0-mg/kg total lidocaine dose. Repeat boluses of 0.5 mg/kg are given at 8-minute intervals.), remember at 360 joules. If no conversion, continue.
* If lindocaine and defibrillation fail to convert VF, give bretylium 5 mg/kg IV push.
* Consider bicarbonate.
* After 1-2 minutes of circulation of bretylium, defibrillate at 360 joules.
* Repeat bretylium 10 mg/kg up to a maximal dose of 30 mg/kg.
* Defibrillate at 360 joules.