lOMoAR cPSD| 5079866
Advanced Cardiac Life
Support
Provider Handbook
By Dr. Karl Disque
2015-2020 (Guidelines and Standard)
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Introduction to ACLS ............ 5
Chapter 1 The Initial Assessment..............6
2 Basic Life Support .............7
3 Initiating the Chain of Survival – 7
2015 BLS Guideline Changes – 8
2010 BLS Guideline Changes – 9
BLS for Adults – 10
One-Rescuer Adult BLS/CPR
Two-Rescuer Adult BLS/CPR
Adult Mouth-to-Mask Ventilation
Adult Bag-Mask Ventilation in Two-Rescuer CPR
Self-Assessment for BLS – 16
Advanced Cardiac Life Support .............18
4 Normal Heart Anatomy and Physiology – 18
The ACLS Survey (ABCD) – 19
Airway Management – 20
Basic Airway Adjuncts
Basic Airway Technique
Advanced Airway Adjuncts
Routes of Access – 24
Intravenous Route
Intraosseous Route
Pharmacological Tools – 25
Self-Assessment for ACLS – 26
Principles of Early Defibrillation ............. 27
5 Keys to Using an Automated External Defibrillator – 28
Criteria to Apply AED
Basic AED Operation
Systems of Care .............. 30
6 Cardiopulmonary Resuscitation – 31
Initiating the Chain of Survival
Post-Cardiac Arrest Care – 32
Therapeutic Hypothermia
Optimization of Hemodynamics and Ventilation
Percutaneous Coronary Intervention
Neurologic Care
Acute Coronary Syndrome – 33
Goals of ACS Treatment
Acute Stroke – 34
Goals of Acute Ischemic Stroke Care
The Resuscitation Team – 35
Education, Implementation, Teams – 36
Self-Assessment for Systems of Care – 37
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Chapter 7 ACLS Cases ..............38
Respiratory Arrest – 38
Ventricular Fibrillation and Pulseless Ventricular Tachycardia – 42
Pulseless Electrical Activity and Asystole – 44
Post-Cardiac Arrest Care – 48
Blood Pressure Support and Vasopressors
Hypothermia
Symptomatic Bradycardia – 51
Tachycardia – 54
Symptomatic Tachycardia with Heart Rate Greater than 100 BPM
Stable and Unstable Tachycardia
Acute Coronary Syndrome – 58
Acute Stroke – 60
Self-Assessment for ACLS Cases – 64
8 ACLS Essentials ............67
9 Additional Tools ...............68
MediCode – 68
CertAlert+ – 68
10 ACLS Review Questions ............ 69
, lOMoAR cPSD| 5079866
TO ACLS
The goal of Advanced Cardiovascular Life Support (ACLS) is to achieve the best possible outcome for
individuals who are experiencing a life-threatening event. ACLS is a series of evidence based
responses simple enough to be committed to memory and recalled under moments of stress. These
ACLS protocols have been developed through research, patient case studies, clinical studies, and
opinions of experts in the field. The gold standard in the United States and other countries is the
course curriculum published by the American Heart Association (AHA).
Previously, the AHA released periodic updates to their Cardio Pulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC) guidelines on a five year cycle, with the most recent update
published in 2015. Moving forward, the AHA will no longer wait five years between updates; instead,
it will maintain the most up-to-date recommendations online at ECCguidelines.heart.org. Health
care providers are recommended to supplement the materials presented in this handbook with the
guidelines published by the AHA and refer to the most current interventions and rationales
throughout their study of ACLS.
Take Note
While ACLS providers should always be mindful of timeliness, it is important to provide the
intervention that most appropriately fits the needs of the individual. Proper utilization of ACLS
requires rapid and accurate assessment of the individual’s condition. This not only applies to the
provider’s initial assessment of an individual in distress, but also to the reassessment throughout the
course of treatment with ACLS.
ACLS protocols assume that the provider may not have all of the information needed from the
individual or all of the resources needed to properly use ACLS in all cases. For example, if a provider
is utilizing ACLS on the side of the road, they will not have access to sophisticated devices to measure
breathing or arterial blood pressure. Nevertheless, in such situations, ACLS providers have the
framework to provide the best possible care in the given circumstances. ACLS algorithms are based
on past performances and result in similar life-threatening cases and are intended to achieve the best
possible outcome for the individual during emergencies. The foundation of all algorithms involves
the systematic approach of the BLS Survey and the ACLS Survey (using steps ABCD) that you will find
later in this handbook.
ACLS – Advanced Cardiac Life Support 5
Advanced Cardiac Life
Support
Provider Handbook
By Dr. Karl Disque
2015-2020 (Guidelines and Standard)
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Introduction to ACLS ............ 5
Chapter 1 The Initial Assessment..............6
2 Basic Life Support .............7
3 Initiating the Chain of Survival – 7
2015 BLS Guideline Changes – 8
2010 BLS Guideline Changes – 9
BLS for Adults – 10
One-Rescuer Adult BLS/CPR
Two-Rescuer Adult BLS/CPR
Adult Mouth-to-Mask Ventilation
Adult Bag-Mask Ventilation in Two-Rescuer CPR
Self-Assessment for BLS – 16
Advanced Cardiac Life Support .............18
4 Normal Heart Anatomy and Physiology – 18
The ACLS Survey (ABCD) – 19
Airway Management – 20
Basic Airway Adjuncts
Basic Airway Technique
Advanced Airway Adjuncts
Routes of Access – 24
Intravenous Route
Intraosseous Route
Pharmacological Tools – 25
Self-Assessment for ACLS – 26
Principles of Early Defibrillation ............. 27
5 Keys to Using an Automated External Defibrillator – 28
Criteria to Apply AED
Basic AED Operation
Systems of Care .............. 30
6 Cardiopulmonary Resuscitation – 31
Initiating the Chain of Survival
Post-Cardiac Arrest Care – 32
Therapeutic Hypothermia
Optimization of Hemodynamics and Ventilation
Percutaneous Coronary Intervention
Neurologic Care
Acute Coronary Syndrome – 33
Goals of ACS Treatment
Acute Stroke – 34
Goals of Acute Ischemic Stroke Care
The Resuscitation Team – 35
Education, Implementation, Teams – 36
Self-Assessment for Systems of Care – 37
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Chapter 7 ACLS Cases ..............38
Respiratory Arrest – 38
Ventricular Fibrillation and Pulseless Ventricular Tachycardia – 42
Pulseless Electrical Activity and Asystole – 44
Post-Cardiac Arrest Care – 48
Blood Pressure Support and Vasopressors
Hypothermia
Symptomatic Bradycardia – 51
Tachycardia – 54
Symptomatic Tachycardia with Heart Rate Greater than 100 BPM
Stable and Unstable Tachycardia
Acute Coronary Syndrome – 58
Acute Stroke – 60
Self-Assessment for ACLS Cases – 64
8 ACLS Essentials ............67
9 Additional Tools ...............68
MediCode – 68
CertAlert+ – 68
10 ACLS Review Questions ............ 69
, lOMoAR cPSD| 5079866
TO ACLS
The goal of Advanced Cardiovascular Life Support (ACLS) is to achieve the best possible outcome for
individuals who are experiencing a life-threatening event. ACLS is a series of evidence based
responses simple enough to be committed to memory and recalled under moments of stress. These
ACLS protocols have been developed through research, patient case studies, clinical studies, and
opinions of experts in the field. The gold standard in the United States and other countries is the
course curriculum published by the American Heart Association (AHA).
Previously, the AHA released periodic updates to their Cardio Pulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC) guidelines on a five year cycle, with the most recent update
published in 2015. Moving forward, the AHA will no longer wait five years between updates; instead,
it will maintain the most up-to-date recommendations online at ECCguidelines.heart.org. Health
care providers are recommended to supplement the materials presented in this handbook with the
guidelines published by the AHA and refer to the most current interventions and rationales
throughout their study of ACLS.
Take Note
While ACLS providers should always be mindful of timeliness, it is important to provide the
intervention that most appropriately fits the needs of the individual. Proper utilization of ACLS
requires rapid and accurate assessment of the individual’s condition. This not only applies to the
provider’s initial assessment of an individual in distress, but also to the reassessment throughout the
course of treatment with ACLS.
ACLS protocols assume that the provider may not have all of the information needed from the
individual or all of the resources needed to properly use ACLS in all cases. For example, if a provider
is utilizing ACLS on the side of the road, they will not have access to sophisticated devices to measure
breathing or arterial blood pressure. Nevertheless, in such situations, ACLS providers have the
framework to provide the best possible care in the given circumstances. ACLS algorithms are based
on past performances and result in similar life-threatening cases and are intended to achieve the best
possible outcome for the individual during emergencies. The foundation of all algorithms involves
the systematic approach of the BLS Survey and the ACLS Survey (using steps ABCD) that you will find
later in this handbook.
ACLS – Advanced Cardiac Life Support 5
