Welcome to the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Recertificaton Course.
All classes at taught at:
Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, Colorado 80918
American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) renewal course is an advanced, instructor-led classroom course that highlights the importance of team dynamics and communication, systems of care and immediate post-cardiac-arrest care. It also covers airway management and related pharmacology. In this course, skills are taught in large, group sessions and small, group learning and testing stations where case-based scenarios are presented.
How to Get Ready
The American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Recertification Course is designed to teach you the lifesaving skills required to be both a team member and a team leader in either an in-hospital or an out-of-hospital setting.
Because the Advanced Cardiac Life Support (ACLS) Renewal Course covers extensive material in a short time, you will need to prepare for the course beforehand.
You should prepare for the course by doing the following:
1. You must purchase the ACLS provider manual for this course and bring it with you to class.
2. Complete the pre-course preparation checklist that came with your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual. Bring the checklist with you to the course.
3. Review and understand the information in your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual. Pay particular attention to the 10 cases in Part 5.
4. The resuscitation scenarios require that your BLS skills and knowledge are current. You will be tested on 1-rescuer adult CPR and AED skills at the beginning of the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Course.
5. Review, understand, and complete the ECG and Pharmacology Pre-course Self-Assessment on the Student Website (www.heart.org/eccstudent).
6. Print your scores for the Pre-course Self-Assessment and bring them with you to class.
What to Bring and What to Wear
Bring your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual to each class. You will need it during each lesson in the course. Please wear loose, comfortable clothing to class. You will be practicing skills that require you to work on your hands and knees, and the course requires bending, standing, and lifting.
If you have any physical condition that might prevent you from engaging in these activities, please tell an instructor. The instructor may be able to adjust the equipment if you have back, knee, or hip problems.
If you have any questions about the course, please call Catherine Brinkley RN at (337) 238-8501 to register.
The course is taught in a STRESS FREE, FUN environment. I want you to leave class feeling like you're glad you came, you learned a lot and you ACTUALLY HAD FUN !!!
You will MASTER all the skills you need to run a code and learn all the rhythms and drugs to treat them. IT'S A PIECE OF CAKE !!! STRESS FREE ! FUN !!
SAVING AMERICAN HEARTS ADVANCED CARDIAC LIFE SUPPORT STUDY GUIDE AND ACLS SUPPLEMENTARY MATERIAL Based on the 2010 Guidelines of the American Heart Association
Always begin Basic Life Support 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 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.
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.
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.
Any patient having chest pain should have an EKG first. You must know if they are having a STEMI.
(ST segment elevation) must go to the cath lab for an angiogram or they will die. The heart muscle is not perfusing.
(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.
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.
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