An Intro to Advanced Life Support
An Intro to Advanced Life Support
by Mackenzie Thompson
Life Saver, NHCPS
posted on Feb 18, 2020, at 10:12 am
Immense value resides within advanced life support training courses. While these courses are traditionally reserved for health professionals, more people are turning to advanced life support training to improve their career outlook and save lives. According to the International Liaison Committee on Resuscitation (ILCOR), cardiac arrest statistics appear to be increasing. More than 475,000 Americans die from cardiac arrest annually. Cardiac arrest causes more deaths than breast cancer, influenza, pneumonia, firearms, house fires, HIV, prostate cancer, and colorectal cancer combined.
Unfortunately, most of these deaths derive from out-of-the-hospital cardiac arrest. Out-of-the-hospital cardiac arrest affects 350,000 people per year, and without immediate life-saving intervention, up to and including advanced life support, the risk of mortality dramatically increases. To understand the value of completing an advanced life-saving skills course, such as the one available here, professionals need to understand the basics of advanced life support. Moreover, they must know its various types, the reversible causes of arrest, and a few other key facts to save lives.
What Is Advanced Life Support
An advanced life support training course teaches participants the skills necessary to save lives that go beyond basic techniques within Basic Life Support (BLS), reports Very Well Health. BLS often accompanies Cardiopulmonary Resuscitation (CPR) courses for non-nursing staff. The difference in this is simple. Advanced life support training includes the administration of medications to overcome the reversible causes of arrest. With that in mind, more organizations are starting to look beyond the perception that only nurses can administer medications, cross-training individuals within the health field, such as Emergency Medical Technicians (EMTs), and beyond. For example, educators, daycare providers, and coaches are now starting to take note of the value of advanced care training.
At its core, advanced life support relies on a series of algorithms to assess the health status of an individual, his or her top health risks, what’s causing the arrest, and how to best treat it. Critical components of an advanced life support course include:
- High-quality chest compressions are integral to the effectiveness of resuscitation.
- The use of the bag-mask.
- How to recognize an impending arrest.
- Airway management.
- Medications used to improve survival chances and achieve a return of spontaneous circulation (ROSC).
- How to respond to someone suffering a cardiac arrest because of a stroke.
- How to communicate as both a participant/responder and leader in response.
Types of Advanced Life Support
Multiple forms of advanced life support exist, including Pediatric Advanced Life Support (PALS), Advanced Cardiac Life Support (ACLS), and even the opioid algorithm.
While the opioid algorithm is not necessarily a traditional form of advanced life support, the prevalence of the opioid epidemic makes it imperative for all health professionals and those that may encounter someone suffering from an opioid overdose. Most importantly, organizations and countries that have implemented robust opioid epidemic algorithms have successfully reduced the risk of opioid deaths.
Going back to the various forms, the different names describe the type of victim that each algorithm can help.
For instance, the ACLS algorithm is most commonly used for adult patients. Meanwhile, the PALS algorithm covers children from birth through adolescence. While PALS does not expressly have the term, cardiac, in its nomenclature, cardiac care remains a vital part of its purpose.
A few other distinctions exist within the forms, such as unique considerations for recognizing arrest in children versus adults. While adults may exhibit bradycardia, an arrhythmia that results in fewer than 60 beats per minute (BPM), any pulse below 60 in children is considered the same as a complete arrest. Therefore, it is prudent to initiate chest compression and life-saving measures, as defined here.
The Cardiac Advanced Life Support Algorithm
Since all algorithms have a common core—treating cardiac and respiratory arrest when present, anyone taking an advanced life support course must understand the cardiac algorithm, which is explained as follows:
1. Activate the emergency response team. In health facilities, the emergency response team may also be known as a code team or a rapid response team. In out-of-the-hospital environments, activating the emergency response involves contacting emergency medical services (EMS) or dialing 911.
2. The next step is simple. Begin CPR. For the purposes of the adult cardiac arrest algorithm, this step includes administering oxygen and attaching the leads to obtain an electrocardiogram (EKG). In out-of-the-hospital environments that lack such a device, this step is replaced by attaching the automated external defibrillator (AED).
3. Assess the rhythm. If it is a shockable rhythm, administer a shock.
- a. At this point, the algorithm moves further away from a traditional BLS approach to care and into advanced care techniques for shockable rhythms.
- b. Perform CPR for two minutes. Obtain an intravenous (IV) or intraosseous (IO) access without interrupting CPR. Also, administer epinephrine every three to five minutes.
- c. Reassess the rhythm. Administer a shock, if appropriate, or move to step 4 for non-shockable scenarios.
4. If it is not a shockable rhythm, the advanced life support algorithm calls for the continuation of CPR and the administration of epinephrine every three to five minutes. Providers should also establish an advanced airway and reassess the rhythm after two minutes. If the rhythm remains non-shockable, continue CPR, and treat reversible causes of arrest.
5. For shockable rhythms only, continue to perform CPR for two minutes, administering epinephrine every three to five minutes. Also, consider establishing an advanced airway.
6. Reassess the rhythm, administering a shock if advised. Remember that the shock will travel through the bed or conductors in contact with the person. As a result, ensure to state, “all clear,” before administering a shock. If the rhythm has switched to a non-shockable rhythm, return to step 4. If shockable, deliver a shock.
7. If the victim does not yet have a ROSC, continue CPR; administer amiodarone or lidocaine. Remember to treat the reversible causes of arrest as well. Return to step 3a.
Reversible Causes of Arrest
The reversible causes of arrest are collectively known as the “Hs and Ts,” shown in a prior post, available here. The causes include:
- Hypoxia or not getting enough oxygen to the brain and body tissues.
- Hypovolemia or the significant loss of body fluids, namely blood.
- Hydrogen ion build-up or acidosis is resulting from metabolic or respiratory distress.
- Hyper/Hypokalemia or the out-of-range level of sodium in the body.
- Hypothermia or the reduction in body core temperature to below 86 F.
- Tension pneumothorax or the presence of air in the thorax, outside the lungs.
- Tamponade or the swelling of the protective sac around the heart.
- Toxins and substances that derive from both eating and accidental exposure to such chemicals.
- Thromboses or blockages within the vessels of the lungs or heart.
Who Needs Training in Advanced Care Techniques
While advanced life support is a necessity for health professionals that oversee acute care facilities, it remains debatable as to who should complete a course outside of the work environment.
According to RegisteredNurseRN.com, anyone that is currently or plans to continue a career in health care beyond entry-level positions should complete an advanced care course. Many employers even require advanced life support training for all new employees, especially recent nursing school graduates.
Other health professionals that should complete training programs include EMTs, nursing students that have not yet graduated, surgical assistants, also known as Scrub Technicians, and more.
Those working in areas with a higher rate of cardiac arrest, including sporting facilities, should consider completing a course as well. Although they may be unable to administer most medications, they may still be able to give epinephrine and naloxone, as long as they are trained to administer medicines from a First Aid kit.
Part of the reasoning for allowing non-health professionals to provide these medications goes back to their ease of use, including auto-injectable epinephrine, and the nasal spray, naloxone.
How Long Does a Course Take
The average course duration varies by provider and student preferences. Students may also choose to take a course in person or online. However, not all online programs are equal, and even if a program maintains all appropriate accreditation, specific employers may still mandate the completion of an in-person training program.
Online courses may also allow participants to study at their preferred pace, taking time to review course materials and prepare for a final examination as quickly as the student deems necessary.
Study Tips for Completing a Training Program
Since advanced care techniques require attention to detail and complete confidence in one’s skill, those that take a course should follow these tips to complete a program and remember its details:
- Write the algorithms on note cards, reviewing them during free time.
- Create flowcharts or other media that help commit information to memory.
- Take advantage of digital multimedia, including videos, training scenarios and other instruction tools, to interact with the course.
- Complete quizzes and a final pretest to review your skills and aptitude before taking the examination.
- Break the course apart into digestible bits, which are easier to remember, but breaking courses into modules is most often only available through online courses.
- Ask your peers for help in reviewing information or understanding key principles within the materials.
Know-How to Save Lives by Completing an Advanced Life Support Program
Advanced life support will save lives. Without immediate care, cardiac arrest is fatal. There is no other way around it. Even those that have previously completed an advanced care course should consider updating their skills. The specific algorithms may change, and according to ECCGuidelines.Heart.Org, new recommendations for the administration of antiarrhythmic drugs were released for PALS in both 2015 and 2018. Now, new recommendations are unveiled annually, based on new evidence-based practices.
Have you ever seen or participated in a life-saving, advanced life support response in or outside of the hospital? If so, share your experiences and how advanced training could have changed your perception and skills. Also, remember to enroll in your advanced skills course, available here, today.