Advanced Cardiac Life Support (ACLS) Certification Course

ACLS Introduction

The Initial Assessment

ACLS Skills Training

ACLS Certification Exam

Adult Cardiac Arrest Algorithm

Adult Cardiac Arrest Algorithm

Adult Cardiac Arrest Algorithm
Figure 29

CPR Quality

  • Push hard (2-2.4″ (5-6 cm)) and fast (100-120 bpm) and allow chest recoil
  • Minimize interruptions
  • Do not over ventilate
  • If no advanced airway, 30:2 compression to ventilation ratio
  • Quantitative waveform capnography
    • If ETCO2 <10 mmHg, attempt to improve CPR quality

Shock Energy

  • Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses should be considered.
  • Monophasic: 360 J

Return of Spontaneous Circulation

  • Return of pulse and blood pressure
  • Sudden sustained increase in PETCO2 (typically ≥ 40 mmHg)
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

  • Supraglottic advanced airway or ET intubation
  • Absolute placement confirmation:

1. Negative Epigastric Auscultation
2. Positive Bilateral Chest Auscultation
3. Vocal Cord Visualization
4. Quantitative ETCO2

  • 10 breaths per minute with continuous chest compressions

Drug Therapy

  • Epinephrine IV/IO Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes after
  • Amiodarone IV/IO Dose: first dose is 300 mg bolus, second dose is 150 mg
  • Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

Reversible Causes

  • Hypovolemia
  • Hypoxia
  • H+(acidosis)
  • Hypothermia
  • Hypo-/hyperkalemia
  • Hypoglycemia
  • Tamponade, cardiac
  • Toxins
  • Tension pneumothorax
  • Thrombosis, pulmonary or coronary
  • Trauma