ACLS MADE EASY FOR HEALTH CARE PROFESSIONALS:

Important Notes:

  • Make sure the scene is safe before approaching the individual and conducting the BLS or ACLS Survey.
  • When encountering an individual who is “down,” the first assessment to make is whether they are conscious or unconscious
  • Adult Chain of survival:
  • Pediatric Chain of survival:



CPR STEPS:

CPR STEPS

  1. Check for the carotid pulse on the side of the neck. Keep in mind to not waste time trying to feel for a pulse; feel for no more than 10 seconds. If you are not sure you feel a pulse, begin CPR with a cycle of 30 chest compressions and two breaths .

  2. Use the heel of one hand on the lower half of the sternum in the middle of the chest 



  3. Put your other hand on top of the first hand. 

  4. Straighten your arms and press straight down . Compressions should be at least two inches into the person’s chest and at a rate of 100 to 120 compressions per minute.

  5. Be sure that between each compression you completely stop pressing on the chest and allow the chest wall to return to its natural position.Allow complete chest recoil.. Leaning or resting on the chest between compressions can keep the heart from refilling in between each compression and make CPR less effective.
  6. After 30 compressions, stop compressions and open the airway by tilting the head and lifting the chin
  2. a. Put your hand on the person’s forehead and tilt the head back
  1. b. Lift the person’s jaw by placing your index and middle fingers on the lower jaw; lift up.
  2. c. Do not perform head-tilt/chin-lift if you suspect the person may have a neck injury. In that case, the jaw-thrust is used.
  3. d. For the jaw-thrust maneuver, grasp the angles of the lower jaw and lift it with both hands, one on each side, moving the jaw forward. If their lips are closed, open the lower lip using your thumb.
  4. Give a breath while watching the chest rise. Repeat while giving a second breath. Breaths should be delivered over one second.
  5. Resume chest compressions. Switch quickly between compressions and rescue breaths to minimize interruptions in chest compressions.

ADULT MOUTH-TO-MASK VENTILATION

In one-rescuer CPR, breaths should be supplied using a pocket mask, if available.

  1. Give 30 high-quality chest compressions.
  2. Seal the mask against the person’s face by placing four fingers of one hand across the top of the mask and the thumb of the other hand along the bottom edge of the mask 

  3. Using the fingers of your hand on the bottom of the mask, open the airway using head-tilt/chin-lift. (Do not do this if you suspect the person may have a neck injury) 

  4. Press firmly around the edges of the mask and ventilate by delivering a breath over one second as you watch the person’s chest rise. 

  5. Practice using the bag valve mask; it is essential to forming a tight seal and delivering effective breaths

ADULT BAG-MASK VENTILATION IN TWO-RESCUER CPR:

If two people are present and a bag-mask device is available, the second rescuer is positioned at the victim’s head while the other rescuer performs high-quality chest compressions. Give 30 high-quality chest compressions.

  1. Deliver 30 high-quality chest compressions while counting out loud 
  2. The second rescuer holds the bag-mask with one hand using the thumb and index finger in the shape of a “C” on one side of the mask to form a seal between the mask and the face, while the other fingers open the airway by lifting the person’s lower jaw 

  3. The second rescuer gives two breaths over one second each .

The ACLS Survey (A-B-C-D):







Airway Management:

Basic airway equipment includes the oropharyngeal airway (OPA) and the nasopharyngeal airway (NPA). The primary difference between an OPA  and an NPA  is that an OPA is placed in the mouth  while an NPA is inserted through the nose. Both airway equipment terminate in the pharynx. 

The main advantage of an NPA over an OPA is that it can be used in either conscious or unconscious individuals because the device does not stimulate the gag reflex.

  • Only use an OPA in unresponsive individuals with NO cough or gag reflex. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration.
  • An NPA can be used in conscious individuals with intact cough and gag reflex. However, use carefully in individuals with facial trauma due to the risk of displacement.
  • Keep in mind that the individual is not receiving 100% oxygen while suctioning. Interrupt suctioning and administer oxygen if any deterioration in clinical picture is observed during suctioning.

Advanced airway equipment includes the laryngeal mask airway, laryngeal tube, esophageal-tracheal tube, and endotracheal tube. Different styles of these supraglottic airways are available.

  • During CPR, the chest compression to ventilation rate is 30:2.
  • If advanced airway is placed, do not interrupt chest compressions for breaths. Give one breath every 6 to 8 seconds.

  • When using peripheral IV route of administration, drugs can take up to two minutes or more to reach central circulation. The effect of medications given may not be seen until even longer. High-quality CPR helps circulate these drugs and is an important part of resuscitation.

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