i
1 1
, Advanced Cardiovascular Life Support Provider Manual
© 2020 American Heart Association
Printed in the United States of America
First American Heart Association Printing October 2020
Acknowledgments
The American Heart Association thanks the following people for their
contributions to the development of this manual: Elizabeth Sinz, MD, MEd;
Kenneth Navarro, MEd, LP; Adam Cheng, MD; Elizabeth A. Hunt, MD,
MPH, PhD; Sallie Johnson, PharmD, BCPS; Steven C. Brooks, MD, MHSc;
Mauricio G. Cohen, MD; Edward C. Jauch, MD, MS; Sarah Livings,
PharmD; Venu Menon, MD; Susan Morris, RN; David Slattery, MD; Brian
K. Walsh, PhD, RRT; Julie Crider, PhD; and the AHA ACLS Project Team.
ACLS Student Resources can be found at eLearning.heart.org. Contact
your Training Center Coordinator for more information about accessing
these before your course.
To find out about any updates or corrections to this text,
visit www.heart.org/courseupdates.
2
ii
2
,Contents
Part 1: Overview of ACLS
Introduction
Course Description and Goal
Course Objectives
Course Design
Course Prerequisites and Preparation
Course Materials
Course Completion Requirements
Advanced Cardiovascular Life Support
Continuous Quality Improvement
Systems of Care
Cardiac Arrest and Post–Cardiac Arrest Systems of Care
STEMI Systems of Care
Stroke Systems of Care
Systematic Approach
BLS Assessment
Primary Assessment
Secondary Assessment
References
Part 2: Preventing Arrest
Recognition: Signs of Clinical Deterioration
Rapid Response
Implementing a Rapid Response System
Acute Coronary Syndromes
Goals for ACS Patients
OHCA Response
Pathophysiology of ACS
Managing ACS: The Acute Coronary Syndromes Algorithm
Symptoms Suggestive of Ischemia or Infarction
EMS Assessment, Care, and Hospital Preparation
3
iii
3
, Immediate ED Assessment and Treatment
Classifying Patients by ST-Segment Deviation
STEMI
Acute Stroke
Overview
Major Types of Stroke
Approach to Stroke Care
Goals of Stroke Care
Critical Time Periods
Application of the Adult Suspected Stroke Algorithm
Stroke Centers and Stroke Units
Immediate General and Neurologic Assessment
Fibrinolytic Therapy
Endovascular Therapy
Begin General Stroke Care
Bradycardia
Overview
Symptomatic Bradycardia
Managing Bradycardia: The Bradycardia Algorithm
Tachycardia: Stable and Unstable
Overview
Approach to Unstable Tachycardia
Managing Unstable Tachycardia: The Adult Tachycardia With a Pulse
Algorithm
Applying the Adult Tachycardia With a Pulse Algorithm to Unstable
Patients
Cardioversion
Synchronized Cardioversion
Stable Tachycardias
Approach to Stable Tachycardia
Managing Stable Tachycardia: The Adult Tachycardia With a Pulse
Algorithm
4
iv
4
1 1
, Advanced Cardiovascular Life Support Provider Manual
© 2020 American Heart Association
Printed in the United States of America
First American Heart Association Printing October 2020
Acknowledgments
The American Heart Association thanks the following people for their
contributions to the development of this manual: Elizabeth Sinz, MD, MEd;
Kenneth Navarro, MEd, LP; Adam Cheng, MD; Elizabeth A. Hunt, MD,
MPH, PhD; Sallie Johnson, PharmD, BCPS; Steven C. Brooks, MD, MHSc;
Mauricio G. Cohen, MD; Edward C. Jauch, MD, MS; Sarah Livings,
PharmD; Venu Menon, MD; Susan Morris, RN; David Slattery, MD; Brian
K. Walsh, PhD, RRT; Julie Crider, PhD; and the AHA ACLS Project Team.
ACLS Student Resources can be found at eLearning.heart.org. Contact
your Training Center Coordinator for more information about accessing
these before your course.
To find out about any updates or corrections to this text,
visit www.heart.org/courseupdates.
2
ii
2
,Contents
Part 1: Overview of ACLS
Introduction
Course Description and Goal
Course Objectives
Course Design
Course Prerequisites and Preparation
Course Materials
Course Completion Requirements
Advanced Cardiovascular Life Support
Continuous Quality Improvement
Systems of Care
Cardiac Arrest and Post–Cardiac Arrest Systems of Care
STEMI Systems of Care
Stroke Systems of Care
Systematic Approach
BLS Assessment
Primary Assessment
Secondary Assessment
References
Part 2: Preventing Arrest
Recognition: Signs of Clinical Deterioration
Rapid Response
Implementing a Rapid Response System
Acute Coronary Syndromes
Goals for ACS Patients
OHCA Response
Pathophysiology of ACS
Managing ACS: The Acute Coronary Syndromes Algorithm
Symptoms Suggestive of Ischemia or Infarction
EMS Assessment, Care, and Hospital Preparation
3
iii
3
, Immediate ED Assessment and Treatment
Classifying Patients by ST-Segment Deviation
STEMI
Acute Stroke
Overview
Major Types of Stroke
Approach to Stroke Care
Goals of Stroke Care
Critical Time Periods
Application of the Adult Suspected Stroke Algorithm
Stroke Centers and Stroke Units
Immediate General and Neurologic Assessment
Fibrinolytic Therapy
Endovascular Therapy
Begin General Stroke Care
Bradycardia
Overview
Symptomatic Bradycardia
Managing Bradycardia: The Bradycardia Algorithm
Tachycardia: Stable and Unstable
Overview
Approach to Unstable Tachycardia
Managing Unstable Tachycardia: The Adult Tachycardia With a Pulse
Algorithm
Applying the Adult Tachycardia With a Pulse Algorithm to Unstable
Patients
Cardioversion
Synchronized Cardioversion
Stable Tachycardias
Approach to Stable Tachycardia
Managing Stable Tachycardia: The Adult Tachycardia With a Pulse
Algorithm
4
iv
4
