Basic Life Support (BLS) and Advanced

Cardiac Life Support(ACLS)

Presentor-Dr Anmol Gera

Moderator- Dr Jigar Sir
• Healthcare providers use a systematic approch
to assess and treat acutely ill or injured
patients for optimum care.
• The goal of Advanced Cardiovascular Life
Support (ACLS) is to achieve the best possible
outcome for individuals who are experiencing
a life-threatening event.
• The resuscitation team’s interventions for a
patient in respiratory or cardiac arrest is to
support and restore effective oxygenation,
ventilation, and circulation with return of
intact neurologic function
 Cardiovascular collapse
and Cardiac arrest

• Cardiovascular collapse Sudden loss of effective

circulation due to cardiac and/or peripheral vascular
factors that may reverse spontaneously
(e.g.,neurocardiogenic syncope, vasovagal syncope)
or require interventions (e.g., cardiac arrest).

• Cardiac arrest is Abrupt cessation of cardiac function

resulting in loss of effective circulation which maybe
reversible by prompt emergency medical
intervention, but will lead to death in its absence
Etiology of Cardiovascular collapse
Risk Factors
 Sudden Cardiac death

• Sudden unexpected death attributed to

cardiac arrest, which if witnessed occurs
within one hour of symptom onset.
• In unwitnessed cases, the definition is often
expanded to include unexpected deaths
where the subject was documented to be
well within the preceding 24 h.
Chain of Events for Cardiac Arrest
 BASIC LIFE SUPPORT

• General concepts of BLS include:

• Quickly starting the Chain of Survival.
• Delivering high-quality chest compressions for
adults, children, and infants.
• Knowing where to locate and understanding
how to use an Automatic External Defibrillator
(AED)
• Providing rescue breathing when appropriate.
• Knowing how to treat choking.
• There is a common acronym in BLS used to
guide providers in the appropriate steps to
assess and treat patients in respiratory and
cardiac distress. This is CAB-D (Circulation,
Airway, Breathing, Defibrillate).
• Cardiopulmonary resuscitation (CPR) is a
series of life saving actions that improve the
chance of survival following cardiac arrest.
 THE INITIAL ASSESSMENT
• 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.
• If the individual is unconscious, then start with the
BLS Survey and move on to the ACLS Survey.
• If they are conscious, then start with the ACLS
Survey.
WHAT TO DO…

APPROACH SAFETY

CHECK RESPONSE

SHOUT FOR HELP

OPEN AIRWAY

CHECK BREATHING

30 CHEST COMPRESSIONS

2 RESCUE BREATHS
• CAB (Compressions, Airway, Breathing)
sequence.
• Emphasis on early initiation of chest
compressions without delay for airway
assessment or rescue breathing has resulted
in improved outcomes.
 Steps Of CPR
ONE-RESCUER BLS/CPR FOR ADULTS
• Check for the carotid pulse on the side of the neck. Keep in mind not to
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 (Figure 4a).

• Use the heel of one hand on the lower half of the sternum in the middle
of the chest (Figure 4b).

• Put your other hand on top of the first hand (Figure 4c).

• Straighten your arms and press straight down (Figure 4d).

• Compressions should be at least two inches into the person’s chest and at
a rate of 100 to 120 compressions per minute.
• Be sure that between each compression you completely stop pressing on
the chest and allow the chest wall to return to its natural position.
Leaning or resting on the chest between compressions can keep the heart
from refilling in between each compression and make CPR less effective.
• After 30 compressions, stop compressions and open the airway by tilting
the head and lifting the chin
• Give a breath while watching the chest rise.

• Resume chest compressions. Switch quickly

between compressions and rescue breaths to
minimize interruptions in chest compressions.
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 (Figure 5a).
3. Using the fingers of your hand on the bottom of the mask, open the airway
using head-tilt or chin-lift maneuver. (Do not do this if you suspect the person
may have a neck injury) (Figure 5b).
4. Press firmly around the edges of the mask and ventilate by delivering a
breath overone second as you watch the person’s chest rise (Figure 5c).
 TWO-RESCUER BLS/CPR FOR ADULTS
rescuer
• Many times there will be a second person available who can act as a
rescuer.
• The rescuer prepares the AED for use and applies the AED pads.
• The rescuer opens the person’s airway and gives rescue breaths.
• Switch roles after every five cycles of compressions and breaths. One
cycle consists of 30 compressions and two breaths.
• Be sure that between each compression you completely stop pressing
on the chest and allow the chest wall to return to its natural position.
Leaning or resting on the chest between compressions can keep the
heart from refilling in between each compression and make CPR less
effective. Rescuers who become tired may tend to lean on the chest
more during compressions; switching roles helps rescuers perform
high-quality compressions.
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 (Figure 6a).
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
(Figure 6b).
3. The second rescuer gives two breaths over one second each
 Recovery position
(lateral recumbent position):

• This position is used to maintain a patent airway in the

unconscious person.
• Place the patient close to a true lateral position with the head
dependent to allow fluid to drain.
• Assure the position is stable.
• Avoid pressure of the chest that could impair breathing.
• Position patient in such a way that it allows turning them onto
their back easily.
• Take precautions to stabilize the neck in case of cervical spine
injury.
• Continue to assess and maintain access of airway.
Avoid the recovery position if it will sustain injury to the patient.
• Chest compressions should be delivered at a rate
of 100 to 120 per minute, because compressions
faster than 120 per minute may not allow for
cardiac refill and reduce perfusion.
• Chest compressions should be delivered to adults
at a depth between 2 to 2.4 inches (5 to 6 cm)
because compressions at greater depths may
result in injury to vital organs.
• Rescuers must allow for full chest recoil in
between compressions to promote cardiac filling.
• Interruptions of chest compressions, including pre- and
post-AED shocks should be as short as possible.
• Compression to ventilation ratio remains 30:2 for an
individual without an advanced airway in place.
• Individuals with an advanced airway in place should receive
uninterrupted chest compressions with ventilations being
delivered at a rate of one every six seconds.
• In cardiac arrest, the defibrillator should be used as soon as
possible.
• Chest compressions should be resumed as soon as a shock
is delivered.
• Standard dose epinephrine (1 mg every 3 to 5
min) is the preferred vasopressor.

• For cardiac arrest that is suspected to be

caused by coronary artery blockage,
angiography should be performed emergently.
• ADVANCED CARDIAC LIFE SUPPORT (ACLS):
refers to a form of management to the cardiac
arrest victims through the use of techniques
such as endotracheal intubations,
administration of drugs, cardiac monitoring,
defibrillation and electrocardiogram
interpretation.
 ACLS
1. Defibrillation

2. ET intubation

3. IV line insertion
THE ACLS SURVEY (A-B-C-D)
 Defibrillation
• Cardioversion is a method to disrupt the
abnormal electrical circuit(s) in the heart and
restore a heart beat back to normal
 PRINCIPLES OF EARLY
DEFIBRILLATION
• When a fatal arrhythmia is present, CPR can provide a small
amount of blood flow to the heart and the brain, but it cannot
directly restore an organized rhythm. The likelihood of
restoring a perfusing rhythm is optimized with immediate CPR
and defibrillation. The purpose of defibrillation is to disrupt a
chaotic rhythm and allow the heart’s normal pacemakers to
resume effective electrical activity.
• Biphasic defibrillators use a variety of waveforms and have
been shown to be more effective for terminating a fatal
arrhythmia.
• If the first shock does not terminate the arrhythmia, it may be
reasonable to escalate the energy delivered if the defibrillator
allows it.
 Types Of Cardioversion

Cardioversion can be "chemical" or "electrical".

► Chemical cardioversion: refers to the use of

antiarrhythmic medications to restore the heart's normal
rhythm.

►Electrical cardioversion : (also known as "direct-current"

or DC cardioversion): is a procedure whereby a
synchronized electrical shock is delivered through the
chest wall to the heart through special electrodes or
paddles that are applied to the skin of the chest and
back.
 Types of Defibrillators
Internal Defibrillators:
This type of defibrillator is designed to provide immediate
defibrillation to high-risk patients .
An implantable cardioverter-defibrillator (often called an
ICD) is a device that briefly passes an electric current
through the heart. It is "implanted," or put in your body
surgically. It includes a pulse generator and one or more
leads. The pulse generator constantly watches your
heartbeat.
Automated External defibrillator (AED): External
defibrillators are typically used in hospitals or ambulances,
but are increasingly common outside the medical areas .
As automated external defibrillators become safer and
 Methods Of Defibrillation
• The shock is generally conducted through the heart
by two electrodes, in the form of two hand-held
paddles or adhesive patches depending on the
variety of the defibrillator.
• One electrode is placed on the right side of the front
of the chest just below the clavicle.
• The other electrode is placed on the left side of the
chest just below the pectoral muscle of breast.
 USING AN AUTOMATED EXTERNAL
DEFIBRILLATOR
• Attach the pads to the upper right side and lower left side of
the individual’s chest
• Once the pads are attached correctly, the device will read the
heart rhythm.
• If the pads are not attached appropriately, the device will
indicate so with prompts.
• Once the rhythm is analyzed, the device will direct to shock
the individual if a shock is indicated. A shock depolarizes all
heart muscle cells at once, attempting to organize its electrical
activity. In other words, the shock is intended to reset the
heart’s abnormal electrical activity into a normal rhythm.
Automated External Defibrillator
 ENERGY TO BE DELIVERED
• MONOPHASIC :
• Defibrillation – 360 J
• Cardioversion for atrial dysrhythmia – 100J →
200 J → 300 J → 360 J

• BIPHASIC :
• Defibrillation is 200 J
• Cardioversion for atrial dysrhthmia – 120 J
• AIRWAY MANAGEMENT
• Basic airway equipment includes the oropharyngeal
airway (OPA) and the nasopharyngeal airway (NPA).
• The main advantage of a 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.
• Advanced airway equipment includes the laryngeal
mask airway, laryngeal tube, esophageal-tracheal
tube, and endotracheal tube.
• SUCTIONING
• Suctioning is an essential component of maintaining a patent
airway. Providers should suction the airway immediately if there
are copious secretions, blood, or vomit. Attempts at suctioning
should not exceed 10 seconds. To avoid hypoxemia, follow
suctioning attempts with a short period of 100% oxygen
administration.

• Monitor the individual’s heart rate, oxygen saturation, and clinical

appearance during suctioning. If a change in monitoring
parameters is seen, interrupt suctioning and administer oxygen
until the heart rate returns to normal and until clinical condition
improves.
ADVANCED AIRWAY ADJUNCTS
 Advanced Airways

• Indications:
• Difficult to open airway using head tilt-chin lift
or jaw thrust maneuvers.
• If you have difficulty forming a seal with the
face mask.
• If the patient requiring continued ventilatory
support.
• When the patient has a high risk for aspiration
• Average depth of intubation:
• adult male is 23cm
• adult female is 21cm
 Admistration of Drugs
• In ACLS, providers have administered drugs via the
intravenous (IV) or the ET route. ET absorption of drugs
is poor, and optimal drug dosing is unknown.
• Therefore, the intraosseous (IO) route is now preferred
when IV access is not available.
• A peripheral IV is preferred for drug and fluid
administration unless central line access is already
available.
• Central line access is not necessary during most
resuscitation attempts, as it may cause interruptions in
CPR and complications during insertion.
• If a drug is given via peripheral route of
administration, do the following:
• Intravenously push bolus injection (unless
otherwise indicated).
• Flush with 20 mL of fluid or saline.
• Raise extremity for 10 to 20 seconds to
enhance delivery of drug to circulation.
 POST-CARDIAC ARREST CARE
• If an individual has a return of spontaneous
circulation (ROSC), start post-cardiac arrest
care immediately. The initial BLS/ACLS
processes are meant to save an individual’s
life, while post-cardiac arrest care is meant to
optimize ventilation and circulation, preserve
heart and brain tissue/function, and maintain
recommended blood glucose levels.
 BLOOD PRESSURE SUPPORT AND
VASOPRESSORS
• Consider blood pressure support in any individual with systolic blood
pressure less than 90 mm Hg or mean arterial pressure (MAP) less
than 65.
• Unless contraindicated, 1 to 2 liters of IV saline or Lactated Ringer’s is
the first intervention.
• When blood pressure is very low, consider vasopressors.
• If no advanced airway, 30:2 compression to ventilation ratio
• Epinephrine is the pressor of choice for individuals who are not in
cardiac arrest.
• Dopamine, phenylephrine, and methoxamine are alternatives to
epinephrine.
• -Norepinephrine is generally reserved for severe hypotension or as a
last-line agent.
 HYPOTHERMIA

• Hypothermia is the only documented

intervention that improves/enhances brain
recovery after cardiac arrest. It can be
performed in unresponsive individuals (i.e.,
comatose) and should be continued for at least
24 hours. The goal of induced hypothermia is
to maintain a core body temperature between
89.6 to 93.2 degrees F (32 to 36 degrees C).
Post Cardiac Arrest Care
Algorithm
 Take Home Messages
• On recognition of a cardiac arrest event, a layperson should
simultaneously and promptly activate the emergency response
system and initiate cardiopulmonary resuscitation (CPR).
• Performance of high-quality CPR includes adequate compression
depth and rate while minimizing pauses in compressions,
• Early defibrillation with concurrent high-quality CPR is critical to
survival when sudden cardiac arrest is caused by ventricular
fibrillation or pulseless ventricular tachycardia.
• Administration of epinephrine with concurrent high-quality CPR
improves survival, particularly in patients with nonshockable
rhythms.
• Recognition that all cardiac arrest events are not identical is critical for
optimal patient outcome, and specialized management is necessary for
many conditions (eg, electrolyte abnormalities, pregnancy, after cardiac
surgery).
• The opioid epidemic has resulted in an increase in opioid-associated out-
of-hospital cardiac arrest, with the mainstay of care remaining the
activation of the emergency response systems and performance of high-
quality CPR.
• Post–cardiac arrest care is a critical component of the Chain of Survival
and demands a comprehensive, structured, multidisciplinary system that
requires consistent implementation for optimal patient outcomes.
• Prompt initiation of targeted temperature management is necessary for all
patients who do not follow commands after return of spontaneous
circulation to ensure optimal functional and neurological outcome.
THANK YOU