ACLS Study Guide – Home – IU School of Medicine

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IU Health ACLS Study Guide
                          Preparing for your upcoming ACLS Class

                                  REVISED SEPTEMBER 2011

      ON APRIL 1, 2011--WE BEGAN TEACHING THE 2010 AHA GUIDELINES. WE HIGHLY
RECOMMEND REVIEWING THE NEW ALGORYHMS FOUND IN THE 2010 ACLS Textbook available
through AHA and other retail outlets.

       The AHA also requests the following in preparation for your ACLS course:
       1.    CPR/AED competency (this will be practiced and evaluated in the ACLS course).
       2.    Understand the 10 cardiac cases found in the ACLS Provider Manual
       3.    Understand the ACLS algorithms for the cases in the ACLS Provider Manual
       4.    Complete the online ACLS Pre-course Self-Assessment on ACLS ECGs and
             pharmacology (ACLS Student Website www.heart.org/eccstudent )




        To successfully pass the ACLS course, AHA requires you successfully manage a mega-
code. A mega-code is hands-on, dynamic, in real time practice of treating a life-threatening
cardiac emergency. The cardiac emergency will include that may include ventricular fibrillation,
ventricular tachycardia with or without pulses, asystole, pulseless electrical activity, bradycardia
and more. In addition, you're required to pass a written exam with a score of  84%.
        In managing a code or cardiac arrest, you will be required to recognize and correctly
identify basic life-threatening rhythms or arrhythmias. You'll be required to assess the patient's
general condition and effectively treat the patient according to ACLS algorithms and
recommendations using the defibrillator and basic cardiac drugs.
        During this course, you will have to perform roles that may be outside your standard
scope of practice during the mega-code practice and testing portion of the class. You'll be
required to be a "team leader" in managing the code, requesting defibrillation, synchronized
cardioversion, CPR, and the correct cardiac drug and dosage when indicated according to ACLS
guidelines. In managing the mega-code, the team leader will assign their team members to
specific roles and responsibilities including: CPR, respiratory management, use of the
defibrillator/monitor, selecting drugs out of the code cart, recorder, etc.
        Though you'll have sufficient time to practice running mega-codes and you'll watch
audio-visual programs presented by the AHA, course preparation is highly recommended to
make your experience valuable toward your education and your successful completion of the
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class. You're encouraged to purchase or borrow an ACLS Provider Manual that offers direction
to a web site and a pre-course assessment. The online pre-course assessment has shown to be
of high value by those who have attended our classes. In addition, the provider manual will
provide you with ACLS algorhythm pocket guides that can be used during your mega-code
testing as a reference. The textbook itself is also a great resource in preparation for your course
and the written exam.

        To offer further guidelines in your preparation for the ACLS course, we at I.U. Health
Emergency Response Training Institute /Emergency Cardiac Care have provided you with the
very basic rhythms and arrhythmias covered in the ACLS course. This is not to be considered a
replacement for the ACLS Student Manual, the online pre-course assessment and other
resources offered by the AHA. Again--we highly encourage you to get a provider manual and
access the website found in the manual for study.




BLS CPR
        BLS CPR changed in 2010. The primary change is from the "ABC" format to " CAB."
After establishing unresponsiveness and calling for a code, check for a pulse in 5 to 10 seconds
then begin compressions immediately, within 10 seconds of arriving at the patient's side. After
thirty compressions, give your first two breaths. The 30:2 ratio then will continue. " Look, listen
and feel" for breathing has been removed from the new guidelines. One other significant
change in 2010, the use of an AED is now indicated for infants.

       Here are the basic steps in BLS:
                  1. Check for responsiveness
                  2. Call for help and an AED
                  3. Check for pulse and simultaneously scan the chest for breathing.
                  4. Begin the thirty compressions (within 10 seconds of arriving at the
                     patient)
                  5. Give two breaths--continue 30:2 ratio.
                  6. Apply the AED as soon as it arrives

NOTES:
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                                                                                                  2
Sinus Bradycardia (sinus rhythm with a rate less than 50)




      Is your patient stable or unstable?
      Stable- monitor closely
      Unstable/ Symptomatic  this patient is showing signs of poor perfusion
      (their heart rate is not fast enough to deliver an adequate volume of blood
      to the body and requires treatment/ intervention) for example:
      hypotensive feels faint, decreased or altered mental status, cool or
      clammy/diaphoretic.
               Administer 0.5mg Atropine. If Atropine is ineffective you now have
               three options:
                    administer Dopamine 2-10 mcg/kg/minute OR
                    Administer Epinephrine infusion: 2  10 mcg per minute
                    Prepare and provide external transcutaneous pacing.
                           Note: if the patient is severely hypotensive,
                           transcutaneous pacing may or may not capture and not
                           be able to produce an adequate profusing pressure. The
                           epinephrine drip or dopamine drip with transvenous
                           pacing with expert consultation should now be
                           considered.



NOTES:
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                                                                                3
Heart Blocks




      Is your patient stable or unstable?
      Stable- monitor closely, seek expert consultation
      Unstable/ Symptomatic  this patient is showing signs of poor perfusion
      (their heart rate is not fast enough to deliver an adequate volume of blood to
      the body and requires treatment/ intervention) for example: low B/P, feels
      faint, decreased or altered mental status, cool or clammy/diaphoretic
               Administer 0.5mg Atropine. But don't rely on atropine in Mobitz
               type II, second-degree block or third-degree block with a new wide
               QRS complex.
               For an unstable Mobitz type II second-degree or third-degree heart
               block patient be prepared for transcutaneous pacing



NOTES:
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                                                                                       4
Supraventricular Tachycardia- SVT (SUSTAINED rapid
narrow complex tachycardia with a rate greater than 150)




      Is your patient stable or unstable?
      Stable- Attempt vagal maneuvers like bearing down or a good hard cough.
      If you're a physician, try carotid massage (I.U. Health policy states only
      physicians can perform carotid massage).
      If vagal maneuvers aren't successful in slowing their heart rate, administer
      6 mg. of Adenosine. What is unique about administering Adenosine is that
      it is a fast-push and fast-acting drug. It may cause a second or two of
      asystole. Therefore, it is only given with a physician order and a physician
      at the bedside per I.U. Health policy. Patient also must be monitored.
      If the first dose of 6 mg isn't successful, ACLS allow you to repeat the
      Adenosine providing 12 mg the second and third time if needed.
      Unstable/ Symptomatic  this patient is showing signs of poor perfusion
      (low B/P, feels faint, decreased or altered mental status, cool or
      clammy/diaphoretic) it may be due to their heart rate is too fast to deliver
      an adequate volume of blood to the body and requires rapid treatment/
      intervention. Provide synchronized cardioversion of 50  100 joules.


NOTES:
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