1.
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the
care of ill, disabled and dying people.
ACLS
management in hospital services
PRESENTED BY-
SAYMA KHAN
NURSING OFFICER
ELMCH
GUIDED BY-
DR.ANJALATCHI
MUTHUKUMARAN
NURSING SUPERINDENTENT
ELMCH, LUCKNOW

2.
ADVANCED CARDIOVASCULAR
LIFE SUPPORT

3.
INTRODUCTION.....
• ACLS refers to a set of
clinical guidelines for the
urgent and emergent
treatment of life-threatening
cardiovascular conditions that
will cause or have caused
cardiac arrest, using
advanced medical
procedures, medications, and
techniques.
NC.

4.
ACLS...
• These life-threatening conditions range from
dangerous arrhythmias to cardiac arrest.
• ACLS algorithms frequently address at least
five different aspects of peri cardiac arrest care-
i. Airway management
ii. Ventilation
iii. CPR compressions
iv. Defibrillation
v. Medications

5.
1-AIRWAY MANAGEMENT
• Maintain patient airway using the head-tilt, chin-
lift.
• Rescue breathing can be mouth-to-
mouth breathing.
• Or airway management by equipments
.

6.
.

7.
2-VENTILATION
In the absence of an advanced airway during CPR,
current guidelines based on very limited evidence
recommend two positive pressure breaths after
every 30 chest compression. These breaths should
be of an inspiratory time of 1 s and produce a visible
chest wall rise.

8.
3-CPR COMPRESSIONS
• CPR is an emergency procedure consisting of
chest compressions often combined with artificial
ventilation.
• Chest compressions for adults between 5cm and
6cm deep and a rate at least 100 to 120 per
minute.
• Chest compression to breathing ratios is set at 30
to 2 in adults

9.
4-DEFIBRILLATION
• Defibrillation depolarize the critical mass of myocardial cell at
once.
• 1st paddle on the right of the chest just below the clavicle.
• 2nd at precordial, region.
• Paddle should be applied with pressure equivalent to 10kg.
Paddle Size-
Adult; 13cm
Children; 8cm
Infant; 4.5cm

10.
5-MEDICATIONS
• Adrenaline(all types of cardiac arrest) 1mg every 3-
5 min.
• Amidarone(VF,VT)- 1st dose:300mg IV bolus, 2nd
dose 150mg.
• Lidocaine (if amidarone is not available)
• Sodium bicabonate(only if cardiac arrest is
associated with hyperkalemia or tricyclic anti-
depressent overdose)
• Calcium gluconate.

11.
ACLS TEAM..
• ACLS generally requires a team
of trained individuals...
i. Team leader
ii. Back up leader
iii. 2 CPR performer
iv. An airway respiratory
specialist
v. An IV access and medication
vi. A monitor, defibrillator or
ventilator attendant
D.

12.
JOB RESPONSIBILITIES OF
ACLS MEMBERS
Understands and are clear about their role
assignments.
Are prepared to fulfill their role and responsibilities.
Have working knowledge regarding algorithms.
Have sufficient practice in resuscitation skills.
Are committed to the success of the ACLS
resuscitation.

13.
PRTOCOLS OF CARDIAC ARREST
ACC. TO ACLS
• 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

14.
• 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
• Spontaneous arterial pressure waves with intra-
arterial monitoring

15.
• Advanced Airway
• Supraglottic advanced airway or ET intubation
• Waveform capnography to confirm and monitor ET
tube placement
• 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

16.
FLOW CHART OF ACLS
UNRESPONSIVE
CALL FOR HELP
START BLS

17.
ATTACH MONITER &
DEFIBRRILATOR WHEN
AVALIABLE
CHECK RHYTHM
1ST SHOCK (150-200
BIAPHASIC)
CPR 30:2 (2min)
2ND SHOCK(150-
360)

18.
CPR30:2 (2min)
ADRENALINE 1MG IV
EVERY 3-5 MIN
3RD SHOCK
CPR 30:2 (2MIN)
IF PULSE PRESENT: START
POST RESUSCITATION CARE

19.
IF PULSE NOT SEEN FURTHER SHOCK AFTER EACH
2 MIN PERIOD OF CPR.
OR
STILL NO PULSE SEEN AND ASYSTOLE SEEN:
CONTINUE THE CPR AND SWTICH ON TO NON
SHOCKABLE TREATMENT.