ACLS (Advanced Cardiac Life Support)

intubation: invasive

ecart
● meds
● IV fluids
● gloves
● face mask
● IV infusion
● endotracheal tube
● ambu bag
● cardiac board
● laryngoscope
● ngt tube
● asepto syringe

petco level: qualitative - yellow (normal)

PRE-ARREST

V TL: Good day I'm (name) your nurse for

visualize, verbalize, vital signs
today, how are you today?
PT: Hi nurse, I'm not okay
TL: LOOK FOR PATIENT'S
CHARACTERISTICS (pale, low capillary
refill, low in energy, feeling weak, grimace)
TL: Can you please describe your feeling?
PT: I can't breath well, as if there was an
elephant foot in my chest
TL: I'm going yo assess your vital signs
maam
TL: ASSESS BP, HR, RR, TEMP, O2 SAT
TL: VERBALIZE VS AND VISUALIZATION
TL: Okay, calm down maam, can you please
pinch my hand? For me to assess your level
of consciousness.
TL: Do still know where you are?
PT: I'm at the zoo

O nasal cannula
oxygen (o2 sat - <94%) ● flow rate 2-4 lpm
● simple & comfortable
● used for precise oxygen delivery
● use w/ caution for pt w/ irregular
breathing patterns
● use humidification to prevent drying of
 nares
face mask
● flow rate 6-10 lpm
● used for short term oxygen therapy
● C/I for pt w/ CO2 retention
NRM (non-rebreather mask)
● flow rate 11-15 lpm
● simple mask that has one-way valve
that prevent exhaled air from returning
to the reservoir bag

M WHITE on the RIGHT, SMOKE over FIRE

monitor

I intravenous - 3 times ka mag iinsert

IV/IO intraosseous - failed for 3 times, direct to the
bone

T SLOW
treatment Atropine: 0.5mg (5cc) + 20cc PNSS for
flushing
Transcutaneous pacing:
● delivery of small electrical current to
temporarily restore electrical activity of
the heart
● demand mode - common
Dopamine: ideally 1mg
● renal: 1-2mcg/kg/min
● cardiac: 5mcg/kg/min
● vasopressor: 10mcg/kg/min
Epinephrine: 2-10mg q 3-5 mins (1-5 doses)

FAST
<90 BP: unstable
>90 BP: stable
Physiologic:
● vagal maneuver: allow the pt to cough
● carotid massage: 10 secs, 1 side
Pharmacologic:
● adenosine: 1st dose - 6mg
2nd dose - 12mg
Sedate:
● valium: diazepam 5mg
● midazolam 1mg
● demerol 50mg
Synchronized cardioversion
● SVT (NCT): 50-100 joules
● VT (WCT): 100 joules
ARREST

SHOCKABLE (VF, pulseless VT)

● hey sir hey sir are you ok, hey sir hey sire are you alright?
● patient has no response
● CHECKING OF CAROTID PULSE: 1, 1001 1002….
● no pulse no breathing
● ACTIVATE CODE BLUE (team arrives)
● 30 compressions:2 breaths per second

SAS (stop - analyze - switch)

● TL: continue high quality compression
● TL: shock 360
● TL: administer epinephrine 1mg + 20cc PNSS for flushing and elevate the hand of the
client (for epinephrine only)
● IV/IO: preparing 1mg of epinephrine & 20cc PNSS, elevating the hand of the client (after
pa ng shock mag aadminister)
● C: charging 360, is everybody clear?
● C: initiating shock in 3,123 - shock delivered

NON - SHOCKABLE (asystole, PEA:pulseless electrical activity)

● CHECK PULSE FOR 5 SECONDS
● continue high quality compression
● administer epinephrine 1mg q 3-5 mins + 20cc PNSS for flushing and elevate the hand
of the client (for epinephrine only)

12 Reversible Conditions H's & T's

● hypoxia
● hypovolemia
● hydrogen ions (acidosis
 ● hyper/hypokalemia
● hypothermia
● tension pneumothorax
● cardiac tamponade
● toxins
● coronary thrombosis
● pulmonary thrombosis

POST ARREST
● JUST KEEP GOING UNTIL ROSC (return of spontaneous circulation) or pronounce
death by the physician
● IF ROSC (+HR, +RR, PETCO 35-45mmHg)
● CI: pt has pulse and breathing
● TL: pt is now on ROSC, we now assess the patient further

C ● make sure pag nag auscultate no bag,

circulation walang nag papump sa ambu bag

AB ● check placement:5 point auscultation - no

airway, breathing gurgling, good air entering (w/ bag)
● materials need for intubation:
○ intubation set
○ gloves
○ laryngoscope
○ ambu bag
○ wire guide (sterile)
○ syringe
○ leukoplast tape (anchor)
○ endotracheal tube:
■ adult:7-8mm
■ pedia: 4-4.5mm
■ neonate: 2-2.5mm (uncuff)
■ geria: 5-6mm
● if mali - aspirate, retract atleast an inch then
reinsert

D ● check gcs - ask pt to squeeze hand

disability ● administer PNSS/PLR 30cc/kg @ 4 degrees
celsius to maintain core body temperature of
32-34 degrees celsius to run for 12-24 hrs
● NGT - for decompression
● X-ray CVP - to r/o chest fracture & verify
status of ET tube

REFER TO THE ICU!