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Algorithm
ProtocolsforAdult AdvancedCardiacLifeSupport
Recommendations
1.That the Adult ACLS algorithm be used as a tool to manage
all adults who require advanced lifesupport.
Resuscitation. 2013;85:82-87
Resuscitation. 2013;85:82-87
• Each 10% improvement
in adherence results in
a ˜30% increase in
ROSC.
Resuscitation. 2013;85:82-87
What is Recommended
• Defibrillation
• Chest Compressions
• Oxygenation
• Medications
• Procedures
Chest Compressions
• Place patient on a firm surface
– Backboard
– Deflation of air mattress
• Had in the middle of the chest
– 5 cm of depression
– Allow complete recoil
• Lifting the hand completely of the chest can improve
recoil
Circulation. 2010;122:S685-705
CPR
• Depth: 5cm
• Rate: 100-120bpm
• Minimise interruptions
• Cycle every 2 minutes or more frequently of required
• ETCO2< 10mmHg = inadequate compressions
MonomorphicVT
PolymorphicVT
PolymorphicVT/TdP
VF
Shockable • 200 Jshock(biphasic)
• Recommended it is
CPR2 minutes reasonable to increase
energy level for
subsequent shocks.
CPRfor 2 minutes
1mg Adrenaline IV/IO
(1 in 1000)
Then every 2nd cycle
CPRfor 2 minutes
Amiodarone 300mg
IV/IO
Nonshockable
Non shockable
CPR2 minutes
CPR2 minutes
Reversiblecauses
4 H’s & 4 T’s
• Hypoxaemia
• Hypovolaemia
• Hyper/hypokalaemia & metabolic disorders
• Hypo/hyperthermia
• Tension pneumothorax
• Tamponade
• Toxins / poisons / drugs
• Thrombosis-pulmonary / coronary
Cardioversion
Rhythm Energy level (biphasic)
Atrial fibrillation 120-200 J(synchronised)
Atrial flutter 50-100 J(synchronised)
SVT 50-100 J(synchronised)
Pulsed VT 100 J(synchronised)
VF/Pulseless VT 200 J(consider increasing if
unsuccessful)
Algorithms for Advanced Cardiac Life
Support 2018
Summary
• All cardiac arrests should follow the ALSalgorithm
• Early defibrillation