Introduction To ACLS,1 INTRODUCTION TO ACLS
EPIDEMIOLOGY In Singapore, every year about 2,400 people suffer from an acute myocardial infarction. Of these about 900 die as a result of sudden cardiac arrest, 520 of them collapsing in the pre-hospital environment. Heart disease is the second commonest cause of death in our country. Every year nearly 1000 people collapse out-ofhospital from heart disease. This amounts to nearly 3 persons per day. The current survival of these is only about 4.5%. Introduction To ACLS,2
Sudden Cardiac Death : Epidemiology 50% of victims are < 75 years old More than 80% of sudden cardiac deaths are due to Ventricular Arrhythmias About 80% of victims had Ischemic Heart Disease Introduction To ACLS,3
Terminal Arrhythmia 157 patients with SCD VT degenerated to VF 62% Primary VF 8% Torsade de pointes 13% Bradyarrhythmias 17% Bayes deluna, Ambulatory sudden cardiac death. Am Heart J, 1989 Introduction To ACLS,4
Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced & Post Resuscitation Care Sequence of events in emergency cardiac care is displayed schematically by chain of survival metaphor Introduction To ACLS,5
Role of ACLS in CPR Last link in chain of survival Early access- early CPR - early defibrillation - early ACLS & Post Resuscitation Care Critical role in hospital resuscitation ACLS is the most important treatment for potential lethal rhythms ie SVTs and VTs Introduction To ACLS,6
Cardiac Arrest From Abnormal Heart Rhythm Survival Rate and Promptness of CPR & ACLS Initiation of CPR (minutes) 0-4 0-4 8-12 8-12 12 + Arrival of ACLS (minutes) 0-8 16 + 8-16 16 + 12 + Survival Rate (%) 43 10 6 0 0 Introduction To ACLS,7
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Time is life Introduction To ACLS,10
Phase 1 BCLS and ACLS need to be integrated Basic foundation of BCLS is extremely important Strong support needed for community skills in CPR Defibrillation Public-access defibrillation Early in-hospital defibrillation Introduction To ACLS,11
Phase 2 Entry 1. Entry vital signs 2. Orderly transfer 3. ABCD baseline measurements 4. Concise history 5. New vital signs Introduction To ACLS,12
Team Organisation in ACLS Team Leader Assesses ABC Endotracheal intubation Identifies ECG rhythm Gives order to defibrillate D1 Orders IV drugs Speaks to relatives Decides disposition of patient Takes charge of debrief N1 Assists D1 in intubation. Documentation Co-ordinates nursing action D1 N2 Cardiac Monitor/Defibrillator Performs CPR. If pulse returns, monitors vital signs, prepares IV drip LEGEND D1 = Doctor 1 D2 = Doctor 2 N1 = Nurse 1 N2 = Nurse 2 Introduction To ACLS,13 D2 Inserts IV line. Executes defibrillation. Gives IV drugs as instructed by D1. Alternates with N2 in performing cardiac compression. Carries out procedures as instructed.
Phase 3 Resuscitation 1 Focus on the primary and secondary ABCDs 2 Decisive, professional, unflappable attitude 3 One voice Introduction To ACLS,14
Phase 4 Resuscitation 4 Information supplied to the leader - Periodic and routine - Upon completion of procedure / medication - Clarification Introduction To ACLS,15
Phase 5 Resuscitation 5 Information supplied by the leader - Primary and secondary assessment information - Team leader s observations Introduction To ACLS,16
Phase 6 Transfer 1 Relinquish care to a team of equal or greater expertise 2 Provide complete, concise, and wellorganised information Introduction To ACLS,17
Phase 7 Critique 1 A critical responsibility 2 Grieving process 3 Education Introduction To ACLS,18
Essentials of ACLS Recognition of cardiac arrest and BCLS Adjuncts for airway control, ventilation and oxygenation ETT Defibrillation Arrhythmia recognition and management - Case Scenarios Intravenous techniques Cardiovascular pharmacology Emergency cardiac pacing Acute coronary syndromes and AMI Introduction To ACLS,19