AHA ACLS, BLS, PALS, NRP, PEARS, ACLS EP, PHTLS and Heartsaver First Aid, CPR/AED Saving American Hearts, Inc 6165 Lehman Drive Suite 202 Colorado Springs, Colorado 80918 Catherine Brinkley (719) 551-1222 email: admin@savingamericanhearts.com

AHA ACLS Advanced Cardiac Life Support Skills Session March 31, 2015 from 3 PM to 5 PM at Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, CO 80918.

AHA ACLS Advanced Cardiac Life Support Skills Session March 31, 2015 from 3 PM to 5 PM at Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, CO 80918.
AHA ACLS Advanced Cardiac Life Support Skills Session March 31, 2015 from 3 PM to 5 PM at Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, CO 80918.
Item# ISBN-13: 9781616690106
$65.00





Welcome to the American Heart Association ACLS Skills Session !

Please see the calendar for dates and times of class.

All classes at taught at:

Saving American Hearts

6165 Lehman Drive Suite 209

Colorado Springs, Colorado 80918



To come to this class you need to complete the Heartcode ACLS Part 1 online testing and bring that certificate with you to class.

Heartcode Part 2 consists of hands on practice Heartcode Part 3 is testing.

You may ask the instructor questions and practice until you are comfortable, before being tested.

You will be tested on your BLS Skills for 1 and 2 person rescuer on an adult and the use of an AED and 1 Megacode Scenario as well as one Bag-Mask Ventilation Scenario.



What is an ACLS Skills Test Like ?

You will first practice and then be tested on:

1). A Bag-Mask Ventilation Scenario

2). 1 Rescuer Adult CPR with a bag mask and AED

3). One Megacode scenario



Here are the details of each:

ACLS Bag Mask Ventilation Testing Checklist:

BLS Survey and Interventions

STEP 1:

Student Checks for responsiveness

* Taps and shouts, "Are you alright ?"

* Scans the chest for movement (5-10 seconds)

STEP 2:

Student activates the emergency response system and gets the AED OR Directs second rescuer to activate the emergency response system and get the AED

STEP 3:

Checks carotid pulse (5-10 seconds) Notes that pulse is present Does not initiate chest compressions or attach AED Performs ventilations at the correct rate of 1 breath every 5-6 seconds (10-12 breaths per minute) with a bag-mask device

Inserts oropharyngeal or nasopharyngeal airway Administers oxygen Performs correct bag-mask ventilation for 1 minute Gives proper ventilation-rate and volume

END OF BAG MASK VENTILATION SKILLS CHECK



ACLS CPR TESTING CHECKLIST

STEP 1:

Student Checks for responsiveness

* Taps and shouts, "Are you alright ?"

* Scans the chest for movement (5-10 seconds)

STEP 2:

Tells someone to activate the emergency response system and get the AED

STEP 3:

Checks carotid pulse (minimum 5 seconds: maximum 10 seconds)

STEP 4:

Bares patient's chest and locates CPR hand position

STEP 5:

Delivers first cycle of compressions at correct rate (acceptable: 18 seconds or less for 30 compressions)

STEP 6:

Gives 2 breaths each over 1 second

STEP 7:

Delivers second cycle of compressions at correct hand position (acceptable: greater than 23 of 30 compressions)

STEP 8:

Gives 2 breaths (1 second each) with visible chest rise

END OF ACLS CPR TESTING SKILLS CHECK





ACLS MEGACODE TESTING CHECKLIST

THERE ARE 6 DIFFERENT MEGACODE SCENARIOS YOU ONLY HAVE TO SUCCESSFULLY COMPLETE 1

Cases 1 and 2 are combined into a single megacode scenario

CASE 1 AND 2 Bradycardia to VF/Pulseless VT to Asystole to ROSC

Team Leader:

* Ensures high-quality CPR at all times

* Assigns team member roles

* Ensures that team members perform well

Bradycardia Management

* Starts oxygen if needed, places monitor, starts IV

* Places monitor leads in proper position

* Recognizes symptomatic bradycardia

* Administers correct dose of atropine

* Prepares for second-line treatment

VF/Pulseless VT Management

* Recognizes VF

* Clears before ANALYZE and SHOCK

* Immediately resumes CPR after shocks

* Appropriate airway management

* Appropriate cycles of drug-rhythm check/shock-CPR

* Administers appropriate drug(s) and doses

Asystole Management

* Recognizes Asystole

* Verbalizes potential reversible causes of asystole/PEA (H's and T's)

* Administers appropriate drug(s) and doses

* Immediately resumes CPR after rhythm checks

Post Cardiac Arrest Care

* Identifies ROSC

* Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for endotracheal intubation and waveform capnography, and orders laboratory tests

* Considers therapeutic hypothermia

END OF MEGACODE TESTING FOR Bradycardia to VF/Pulseless VT to Asystole to ROSC





CASE 3 and CASE 5 are exactly the same Tachycardia to VF/Pulseless VT to PEA to ROSC

Team Leader:

* Ensures high-quality CPR at all times

* Assigns team member roles

* Ensures that team members perform well

Tachycardia Management

* Starts oxygen if needed, places monitor, starts IV

* Places monitor leads in proper position

* Recognizes unstable tachycardia

* Recognizes symptoms due to tachycardia

* Performs immediate synchronized cardioversion

VF/Pulseless VT Management

* Recognizes VF

* Clears before ANALYZE and SHOCK

* Immediately resumes CPR after shocks

* Appropriate airway management

* Appropriate cycles of drug-rhythm check/shock-CPR

* Administers appropriate drug(s) and doses

PEA Management

* Recognizes PEA

* Verbalizes potential reversible causes of asystole/PEA (H's and T's)

* Administers appropriate drug(s) and doses

* Immediately resumes CPR after rhythm checks

Post Cardiac Arrest Care

* Identifies ROSC

* Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for endotracheal intubation and waveform capnography, and orders laboratory tests

* Considers therapeutic hypothermia

END OF MEGACODE TESTING FOR Tachycardia to VF/Pulseless VT to PEA to ROSC





CASE 4 and CASE 6 are exactly the same

Tachycardia to VF/Pulseless VT to PEA to ROSC

Team Leader:

* Ensures high-quality CPR at all times

* Assigns team member roles

* Ensures that team members perform well

Tachycardia Management

* Starts oxygen if needed, places monitor, starts IV

* Places monitor leads in proper position

* Recognizes tachycardia (specific diagnosis)

* Recognizes no symptoms due to tachycardia

* Attempts vagal maneuvers

* Gives appropriate initial drug therapy

VF/Pulseless VT Management

* Recognizes VF

* Clears before ANALYZE and SHOCK

* Immediately resumes CPR after shocks

* Appropriate airway management

* Appropriate cycles of drug-rhythm check/shock-CPR

* Administers appropriate drug(s) and doses

PEA Management

* Recognizes PEA

* Verbalizes potential reversible causes of asystole/PEA (H's and T's)

* Administers appropriate drug(s) and doses

* Immediately resumes CPR after rhythm checks

Post Cardiac Arrest Care

* Identifies ROSC

* Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for endotracheal intubation and waveform capnography, and orders laboratory tests

* Considers therapeutic hypothermia

END OF MEGACODE TESTING FOR Tachycardia to VF/Pulseless VT to PEA to ROSC



CASE 5 (Exactly the same as Case 3) Tachycardia to VF/Pulseless VT to PEA to ROSC

Team Leader:

* Ensures high-quality CPR at all times

* Assigns team member roles

* Ensures that team members perform well

Tachycardia Management

* Starts oxygen if needed, places monitor, starts IV

* Places monitor leads in proper position

* Recognizes unstable tachycardia

* Recognizes symptoms due to tachycardia

* Performs immediate synchronized cardioversion

VF/Pulseless VT Management

* Recognizes VF

* Clears before ANALYZE and SHOCK

* Immediatley resumes CPR after shocks

* Appropriate airway management

* Appropriate cycles of drug-rhythm check/shock-CPR

* Administers appropriate drug(s) and doses

PEA Management

* Recognizes PEA

* Verbalizes potential reversible causes of asystole/PEA (H's and T's)

* Administers appropriate drug(s) and doses

* Immediately resumes CPR after rhythm checks

Post Cardiac Arrest Care

* Identifies ROSC

* Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for endotracheal intubation and waveform capnography, and orders laboratory tests * Considers therapeutic hypothermia

END OF MEGACODE TESTING FOR Tachycardia to VF/Pulseless VT to PEA to ROSC



CASE 6 (Exactly the same as Case 4)

Tachycardia to VF/Pulseless VT to PEA to ROSC

Team Leader:

* Ensures high-quality CPR at all times

* Assigns team member roles

* Ensures that team members perform well

Tachycardia Management

* Starts oxygen if needed, places monitor, starts IV

* Places monitor leads in proper position

* Recognizes tachycardia (specific diagnosis)

* Recognizes no symptoms due to tachycardia

* Attempts vagal maneuvers

* Gives appropriate initial drug therapy

VF/Pulseless VT Management

* Recognizes VF

* Clears before ANALYZE and SHOCK

* Immediately resumes CPR after shocks

* Appropriate airway management

* Appropriate cycles of drug-rhythm check/shock-CPR

* Administers appropriate drug(s) and doses

PEA Management

* Recognizes PEA

* Verbalizes potential reversible causes of asystole/PEA (H's and T's)

* Administers appropriate drug(s) and doses

* Immediately resumes CPR after rhythm checks

Post Cardiac Arrest Care

* Identifies ROSC

* Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for endotracheal intubation and waveform capnography, and orders laboratory tests

* Considers therapeutic hypothermia

END OF MEGACODE TESTING FOR Tachycardia to VF/Pulseless VT to PEA to ROSC



Please call/text Catherine Brinkley at (337) 238-8501 or email admin@savingamericanhearts.com with any questions you may have.

I look forward to meeting you ! Have an awesome day !



SAVING AMERICAN HEARTS ADVANCED CARDIAC LIFE SUPPORT STUDY GUIDE Based on the 2010 Guidelines of the American Heart Association



Always begin with chest compressions, not breaths. Give 30 compressions and 2 breaths.

5 cycles of 30 compressions and 2 breaths = 2 minutes. Check for a pulse every 2 minutes, and switch providers every 2 minutes so that the person giving compressions does not get too tired.

Good quality compressions must be given. For adults, compress at least 2 inches or 5 cm. Always let the chest completely recoil.

Provide at least 100 compressions per minute.

Do not spend more than 5 - 10 seconds assessing the patient, or checking for a pulse.

If you are unsure if they have a pulse, begin chest compressions.

Keep interruptions in chest compressions to 10 seconds or less.

WAVEFORM CAPNOGRAPHY

Waveform capnography is written as PETCO2 (Patient End Tidal CO2) The normal is 35-40.

If your PETCO2 number is less than 10, this indicates ineffective chest compressions.

Waveform capnography is used to measure CPR quality and determine ROSC (Return of Spontaneous Circulation).

Waveform capnography is the MOST reliable indicator of ETT placement. If the person doing the intubation happens to get the ETT into the esophagus vs the trachea, there would be no waveform capnography reading.

RESCUE BREATHING

When providing breaths, if doing compressions give 30 compressions and 2 breaths. Each breath should be given over 1 second, and only until you see the chest rise. Giving a bigger breath will only fill the stomach with air which will compress the diaphragm, chest and lungs making it difficult to resuscitate your patient.

If your patient has a pulse and simply cannot breath, provide breaths at a rate of 1 breath every 5-6 seconds = 10-12 breaths/min.

If your patient is intubated (has an advanced airway ), provide 1 breath every 6-8 seconds = 8-10/min. When an advanced airway is in place, compressions should not be paused to give breaths.

GUIDELINES FOR SYNCHRONIZED CARDIOVERSION

UNSTABLE ATRIAL FIBRILATION

The initial BIPHASIC energy dose should be between 120-200 Joules

UNSTABLE SVT OR UNSTABLE ATRIAL FLUTTER The initial BIPHASIC energy dose should be between 50-100 Joules

RHYTHMS WITH MONOPHASIC WAVEFORMS

The initial MONOPHASIC or BIPHASIC energy dose should begin with 200 Joules and increase in a stepwise fashion if not successful

UNSTABLE MONOMORPHIC VT

The initial MONOPHASIC or BIPHASIC energy dose of 100 Joules If the initial shock fails, always increase the dose in a stepwise fashion.

THERAPUTIC HYPOTHERMIA

Used only when your patient remains unresponsive following cardiac arrest, especially those who presented with an initial rhythm of v-fib. These patients are cooled to 32-34 degrees celsius for 12-24 hours. If your patient wakes up and follow commands, do not start hypothermia protocol.

CHEST PAIN

Any patient having chest pain should have an EKG first. You must know if they are having a STEMI.

STEMI

(ST segment elevation) must go to the cath lab for an angiogram or they will die. The heart muscle is not perfusing.

NSTEMI

(ST depression) usually are able to go home on blood thinners.

The only exception to the EKG first, is a patient where the chest pain is caused by their heart rate. If they are unstable, synchronized cardio version should be the first treatment.

So, if an ambulance is bringing you a STEMI patient, and your facility does not have the capabilities to do a heart cath, or angiogram, these patients need to be diverted to a specialty cardiac hospital even if itís an hour away. If you accept the patient, you then have to get admit orders, have consents signed, do the whole med rec and then get transfer orders, find an accepting doctor and transfer the patient anyway. The patient would be better off getting closer to the special hospital.

STROKE

The same goes for the stroke patients, if your hospitalís CT scan is broken, you need to divert them as well. Anyone with stroke symptoms should have their blood sugar checked FIRST.

Numerous people come to ER with decreased LOC, slumping to one side and slurred speech because they took their insulin this morning and havenít eaten all day. Checking blood sugar is a really fast way to rule out a stroke.

The SECOND thing you want to do is called a Cincinnati Pre-Hospital Stroke Assessment Scale.

Itís a very quick assessment Check for FACIAL DROOP, SLURRED SPEECH, and ARM DRIFT.

The THIRD thing you need to do is get that CT SCAN. You need to know if they are having an ischemic stroke or a hemorrhagic stroke. If they are bleeding, they will not get the fibrinolytics.

Atropine is no longer used in the AYSTOLE/PEA Algorithm The American Heart Association defines PEA as sinus rhythm without a pulse.

Atropine is the first line treatment for any bradycardia regardless of the type, a dopamine drip should be started at 2-10 mcg/kg/min if the rhythm is a 3rd degree block. Run the dopamine until pacing begins.

The preferred method of epinephrine administration is via peripheral. During a code there is no time to obtain central venous access.

When attempting IV access, peripheral access should be tried first, if that is unsuccessful move to I/O access. The recommended fluid bolus for a patient who achieves ROSC and is hypotensive is 1-2 Liters. You want to get a minimal SBP of at least 90 to ensure perfusion. Once your patient achieves ROSC you need to make sure they are oxygenated and ventilated. This is now your first priority.

Providing quality chest compressions immediately before a defibrillation attempt will improve successful conversion of V-Fib.

The American Heart Association says that it is acceptable to stop resuscitation efforts if the patient has not had a pulse for 15 consecutive minutes. Except in special cases of drowning or hypothermia.

Always be aware of safety hazards. Donít ever cut adult pads in half or shock a patient if there is oxygen blowing across their chest. The oxygen combined with the electric spark could cause a small explosion or ball of fire that injures everyone in the room.

When possible, use the hands free pads. Paddles take much longer to deliver a shock because you must add the conduction jelly and after the shock is delivered, someone is stuck holding them.

Always provide chest compressions while the defibrillator is charging. The time it takes to analyze is several seconds, you want to make the hands-off period of time as short as possible. Some defibrillators can take up to 45 seconds to charge.

Remember when suctioning a patient, do not suction for longer than 10 seconds.

Always make sure you have a 6 second rhythm strip if you are going to be counting the QRSs by 10 to get your heart rate. If you have a 12 second strip and do this you are likely to end up with a heart rate of 80 when itís actually only 40. The treatment is significantly different.

Always make sure the scene is safe before providing any help to someone. It would not do anyone any good if you ran out into the middle of the street to save someone and get hit by a car. Make sure You assess the scene for safety hazards first.

The initial priority for ANY tachycardia is do they have a pulse or not. The treatment for each is completely different.

The only rhythm you will ever shock is V-Fib and pulseless V-Tach.

The only rhythm you will ever cardiovert is an unstable tachycardia whether itís SVT or atrial does not matter. When placing ties circumferentially around a patientís neck to secure the airway, be sure you donít make it so tight that you cut off venous return to the brain.

Vasopressin can only be used in place of the first or second dose of epinephrine.

Cricoid pressure is no longer recommended. It used to be done routinely, when providers were attempting to occlude the esophagus and prevent vomiting, however inexperienced providers were also unknowingly occluding their airway too. So It is not longer recommended.

http://www.savingamericanhearts.com Catherine Brinkley (719) 551-1222 Saving American Hearts, Inc 6165 Lehman Drive Suite 202 Colorado Springs, Colorado 80918 admin@savingamericanhearts.com