Advanced cardiac life support: Difference between revisions
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imported>Robert Badgett m (→Treatment) |
imported>Howard C. Berkowitz (Some starting points, partially from an EMS perspective) |
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* [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58/FIG1 Pulseless Arrest Algorithm]<ref name="pmid16314375_Part_7.2">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.2: Management of Cardiac Arrest |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58 |issn=}}</ref> | * [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58/FIG1 Pulseless Arrest Algorithm]<ref name="pmid16314375_Part_7.2">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.2: Management of Cardiac Arrest |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58 |issn=}}</ref> | ||
* [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67/FIG1 Bradycardia Algorithm.]<ref name="pmid16314375_Part_7.3">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67 |issn=}}</ref> | * [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67/FIG1 Bradycardia Algorithm.]<ref name="pmid16314375_Part_7.3">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67 |issn=}}</ref> | ||
* [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67/FIG2 ACLS Tachycardia Algorithm.]<ref name="pmid16314375_Part_7.3">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67 |issn=}}</ref> | * [http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67/FIG2 ACLS Tachycardia Algorithm.]<ref name="pmid16314375_Part_7.3">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67 |issn=}}</ref> | ||
==Ethical issues== | |||
===When not to start ACLS=== | |||
In a particular jurisdiction, this may have legal constraints, or operational ones such as standing orders from the medical director of an [[emergency medical system]] (EMS). This kind of emotionally draining decision is apt to be most straightforward when a patien's medical records are readily available and contain an explicit "Do Not Resuscitate" (DNR) or "Do Not Attempt Resuscitation" request from the patient or a surrogate with the appropriate authority. | |||
This can be much more difficult in the field. Most EMS systems have rules for the obvious cases when any life support would be futile, such as decapitation or decomposition. A current controversy deals with certain kinds of trauma, where, variously, | |||
#With reasonable medical certainty, there is no possibility of resuscitation with all possible resources. Finding a victim who is pulseless and has sustained major blunt chest trauma is the usual example where death is not obvious | |||
#Situations where ACLS will not help, but immediate surgical intervention has some chance. Current thinking is that the appropriate treatment for exsanguinating hemorrhage is not fluids, not ACLS, but immediately opening the chest for manual heart compression and, perhaps, emergency repair or control of a vascular injury. In such a situation, if there is minimal but not absent cardiac activity, and there is a facility nearby prepared for emergency thoracotomy, the ACLS "treat until stable" is less appropriate than "scoop and run". | |||
===When to terminate ACLS=== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 10:25, 20 July 2008
In healthcare, Advanced cardiac life support is "the use of sophisticated methods and equipment to treat cardiopulmonary arrest. Advanced Cardiac Life Support (ACLS) includes the use of specialized equipment to maintain the airway, early defibrillation and pharmacological therapy."
Treatment
Clinical practice guidelines for advanced cardiovascular life support by the American Heart Association provide treatment algorithms:[1]
- Adult BLS Healthcare Provider Algorithm[2]
- Pulseless Arrest Algorithm[3]
- Bradycardia Algorithm.[4]
- ACLS Tachycardia Algorithm.[4]
Ethical issues
When not to start ACLS
In a particular jurisdiction, this may have legal constraints, or operational ones such as standing orders from the medical director of an emergency medical system (EMS). This kind of emotionally draining decision is apt to be most straightforward when a patien's medical records are readily available and contain an explicit "Do Not Resuscitate" (DNR) or "Do Not Attempt Resuscitation" request from the patient or a surrogate with the appropriate authority.
This can be much more difficult in the field. Most EMS systems have rules for the obvious cases when any life support would be futile, such as decapitation or decomposition. A current controversy deals with certain kinds of trauma, where, variously,
- With reasonable medical certainty, there is no possibility of resuscitation with all possible resources. Finding a victim who is pulseless and has sustained major blunt chest trauma is the usual example where death is not obvious
- Situations where ACLS will not help, but immediate surgical intervention has some chance. Current thinking is that the appropriate treatment for exsanguinating hemorrhage is not fluids, not ACLS, but immediately opening the chest for manual heart compression and, perhaps, emergency repair or control of a vascular injury. In such a situation, if there is minimal but not absent cardiac activity, and there is a facility nearby prepared for emergency thoracotomy, the ACLS "treat until stable" is less appropriate than "scoop and run".
When to terminate ACLS
References
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 4: Adult Basic Life Support". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.2: Management of Cardiac Arrest". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ 4.0 4.1 (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.