ACLS

How to prepare for an ACLS course?

ACLS Precourse Requisites

Preparing for your AHA ACLS renewal and Heartcode skills check-off test will likely be a part of your necessary training as a healthcare provider. ACLS protocols encompass numerous invasive procedures that involve both basic and advanced life support procedures. Typically a certification takes 10-12 hours, and you can prepare for it ahead of time by becoming familiar with its algorithms. If you are taking an in-person ACLS renewal course a precourse assessment and precourse work is necessary to attend the class. In the precourse assessment, you will be tested on knowledge of clinical scenarios and ACLS protocols. The precourse work outlines important concepts of ACLS in video format and it will prepare you to answer questions following each video segment. In the Heartcode you will take the majority of the ACLS course online thru a computer adaptive learning program. The Heartcode ACLS targeted at healthcare professionals who are first responders to cardiac-related emergencies. The course mainly reflects resuscitation and emergency cardiovascular care. Students will learn recognition and early management of respiratory and cardiac arrest, periarrest conditions, and airway management. Students will also learn to effectively communicate as a part of a resuscitation team. In both cases, you will need basic knowledge of BLS in the adult population, ECG rhythm interpretation, pharmacology used in ACLS. We have a table below that will help you obtain your certification through CPR Training Austin.

PrerequisiteMeasurementsResources
BLSBe able to perform high-quality CPR in adults, AED use, and bag-mask valve ventilationBLS Course
ACLS Provider Manual
ECG rhythm interpretationBe able to identify on a monitor and paper tracing
-Normal sinus rhythm
-Sinus bradycardia
-Type I second degree AV block
-Type II second degree AV block
-Third degree AV block
-Sinus tachycardia
-Superventricular tachycardia
-Atrial fibrillation
-Atrial flutter
-Ventricular tachycardia (monomorphic and polymorphic)
-Asystole
-Ventricular fibrillation
-Organized rhythm without a pulse
-PEA
ACLS Provider Manual
PharmacologyHave basic understanding of essential drugs used in
-Cardiac arrest
-Bradycardia
-Tachycardia with adequate perfusion
-Tachycardia with poor perfusion
-Post cardiac arrest care
-ACS
-Stroke
ACLS Provider Manual
1. Adenosine
– Indications: Supraventricular tachycardia (SVT)
– Dosage: 6 mg rapid IV push; if ineffective, 12 mg can be given one to two times2. Amiodarone
– Indications: Ventricular fibrillation (VF), ventricular tachycardia (VT)
– Dosage: 300 mg IV/IO for cardiac arrest; post-resuscitation, 150 mg IV over 10 minutes3. Atropine
– Indications: Symptomatic bradycardia
– Dosage: 1 mg IV every 3-5 minutes as needed, not to exceed 3 mg4. Dopamine
– Indications: Symptomatic bradycardia with hypotension, shock
– Dosage: 5-20 mcg/kg/min infusion5. Epinephrine– Indications: Cardiac arrest (VF, pulseless VT, asystole, PEA), symptomatic bradycardia with hypotension
– Dosage: Cardiac arrest: 1 mg IV/IO every 3-5 minutes; for bradycardia: 2-10 mcg/min infusion, titrate to patient response6. Lidocaine
– Indications: VF, pulseless VT unresponsive to shock delivery, CPR, and vasopressors
– Dosage: 1-1.5 mg/kg IV/IO; if refractory VF/VT, additional 0.5-0.75 mg/kg IV push may be given at 5-10 minute intervals to a maximum dose of 3 mg/kg7. Magnesium Sulfate
– Indications: Torsades de Pointes, hypomagnesemia, seizures due to eclampsia
– Dosage: Torsades de Pointes: 1-2 g IV/IO diluted in 10 mL D5W given over 5-20 minutes; for seizures due to eclampsia: 4-6 g IV in 100 mL over 15 minutes8. Vasopressin
– Indications: Alternative to epinephrine in cardiac arrest
– Dosage: 40 units IV/IO once onlyDetailed ACLS Drug TableACLS EKG ReviewEKG PracticeIntraosseous PlacementAttaching IV Line: Learn to attach an IV line and give an IO fluid bolus.Establishing IV Access: Understand the procedure for establishing IV access.Oxygen Delivery Systems and Airway ManagementHigh-Flow vs Low-Flow Oxygen Delivery SystemsHigh-flow: O2 flow exceeds patient inspiratory flow, preventing entrainment of room air if the system is tight-fitting. It delivers nearly 1.00 FiO2. Examples include nonrebreathing mask with reservoir, high-flow nasal cannula.Low-flow (≤10L/min): Patient inspiratory flow exceeds O2 flow, allowing entrainment of room air. It delivers 0.22 to 0.60 FiO2. Examples include standard nasal cannula, simple O2 mask.Nasal Cannula Flow RateThe maximum flow rate for a standard nasal cannula is 4 L/min.Airway Opening TechniquesUse the head tilt–chin lift maneuver while keeping the mouth open.Use the jaw thrust for trauma victims.Indications for Oropharyngeal Airway (OPA) and Nasopharyngeal Airway (NPA)OPA: Only for unconscious victims without a gag reflex.NPA: For conscious or semi-conscious victims.Selecting and Inserting an AirwayMeasure the correct size of the OPA from the corner of the mouth to the angle of the mandible.Insert the OPA correctly.Assessment After OPA InsertionVerbalize how to assess for adequate breathing after the insertion of an OPA.Mask Selection for VentilationSelect the correct mask size for ventilation.Suctioning with OPASuction with the OPA in place. Suctioning should not exceed 10 seconds.Assembling Bag-Mask DeviceAssemble the bag-mask device, open the airway, and create a seal using the E-C clamp technique.Application 3 ECG lead• Negative(white)lead: to right shoulder
• Positive(red)lead:to left lower ribs
• Ground(black,green,brown)lead:to left shoulder

Megacode Example

You are called to evaluate a 70-year-old man complaining of chest pain and shortness of breath who is inpatient at the hospital

What are your initial actions?

  • STEMI inferior, bradycardia, hypoxia
    • Place supplemental oxygen
    • Activate cath lab
    • Asprin
    • Avoid Nitroglycerin in this case inferior MI

Upon waiting in the cath lab your patient goes unresponsive and pulseless and you see this on the monitor

  • Patient is in pulseless V-tach
    • Place AED deliver an unsynchronized shock
    • Begin high-quality CPR 30 compressions: 2 breaths with bag-mask ventilation at 100% oxygen
    • Check pulse/breathing/rhythm every 2 minutes
  • The patient is in Ventricular Fibrillation
    • Continue vF algorithm
      • Deliver AED shock
      • High-quality CPR
      • Epinephrine after 2nd shock
      • Amiodarone after 3rd shock
    • Assess pulse/breathing/rhythm every 2 mins
  • The patient is in PEA with no pulse/breathing
  • Continue high-quality CPR
  • Administer Epi 1 mg every 3-5 mins

Be able to recognize all arrhythmias (VT, VF, SVT, heart blocks, bradycardias, tachycardias), guide treatments for each, and follow algorithms for each you will be the team leader!

Cardiac Rhythm Study Guide

## 1. Normal Sinus Rhythm
– Description: Regular rhythm with rate of 60-100 bpm. Each QRS complex is preceded by a normal P wave.
– Treatment: None, this is the normal heart rhythm.

## 2. Sinus Bradycardia
– Description: Regular rhythm with rate less than 60 bpm. Each QRS complex is preceded by a normal P wave.
– Treatment: If symptomatic, consider atropine, pacemaker or dopamine.

## 3. Supraventricular Tachycardia (SVT)
– Description: Regular rapid rhythm with rate of 150-220 bpm.
– Treatment: Valsalva maneuvers, adenosine, beta-blockers, or cardioversion if unstable.

## 4. Pulseless Ventricular Tachycardia
– Description: Rapid ventricular rhythm with rate of 100-250 bpm.
– Treatment: Immediate defibrillation, followed by CPR and administration of epinephrine and amiodarone as per ACLS protocols.

## 5. Ventricular Tachycardia with a Pulse
– Description: Rapid ventricular rhythm with rate of 100-250 bpm.
– Treatment: If stable, amiodarone or lidocaine. If unstable, synchronized cardioversion.

## 6. Ventricular Fibrillation
– Description: Chaotic rhythm with no identifiable waves or complexes.
– Treatment: Immediate defibrillation, followed by CPR and administration of epinephrine and amiodarone as per ACLS protocols.

## 7. 1st Degree Heart Block
– Description: Regular rhythm with prolonged PR interval (>0.20 sec).
– Treatment: No specific treatment, monitor for progression to higher degrees of heart block.

## 8. 2nd Degree Heart Block Type 1 (Wenckebach)
– Description: Gradually lengthening PR interval until a beat is dropped (QRS complex is absent).
– Treatment: Typically no treatment is necessary unless symptomatic, in which case a pacemaker might be needed.

## 9. 2nd Degree Heart Block Type 2 (Mobitz II)
– Description: Regular or irregular rhythm with dropped beats (QRS complex is absent) that are not preceded by a lengthening PR interval.
– Treatment: May require pacemaker, as this can progress to 3rd degree heart block.

## 10. 3rd Degree Heart Block
– Description: No communication between atria and ventricles. Atrial and ventricular rhythms are regular but independent of each other.
– Treatment: Immediate pacemaker.

## 11. Atrial Fibrillation
– Description: Irregular rhythm with no discernible P waves.
– Treatment: Rate control with beta-blockers or calcium channel blockers, anticoagulation, and possibly cardioversion.

## 12. Atrial Flutter
– Description: Regular or irregular rhythm with “sawtooth” P waves.
– Treatment: Rate control with beta-blockers or calcium channel blockers, anticoagulation, and possibly cardioversion or ablation.

## 13. PEA/Asystole
– Description: No discernible rhythm or electrical activity.
– Treatment: Immediate CPR and epinephrine. Consider reversible causes (H’s and T’s).

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