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Advanced Cardiovascular Life Support

Prestudy

Agenda for Recertification

8:00 Welcome/Introduction

8: 15 AHA ACLS Overview Video

8:30 Instructor presentation of lethal rhythms & pretest

8:45 AHA Video ACLS Primary/Secondary Survey

Instructor presentation of 2011 BLS

9:00 AHA ACLS Video Airway Management

9:30 AHA BLS Video

9:45 Practice BLS with manikins/BMV/Barrier/AED

10:00 Instructor presentation of ACLS

11:00 AHA video of Heart Attack and Stroke

12:00 AHA video of Mega Code

12:15 Instructor presentation of Mega Code

Skills stations

Written exam

Agenda for Certification Day One 8:00 Welcome, Introduction, Pretest 8:30 Lethal Rhythm Review & Practice 9:30 Primary and Secondary Survey Video/Practice

10:00 Airway Management

11:00 BLS Practice

12:00 Lunch

1:00 VF/PEA/Asystole

2:00 Bradycardias

Tachycardias

Acute Coronary Syndrome/Stroke

Practice Skills

Airway Management

Defibrillation

Cardioversion

3:00 Scenario Discussions if time allows

4:00 Mega Code instructor presentation

Day Two 8:00 Putting it all together

9:00 Mega Code Review

10:00 Mega Code and Written evaluation

11:00 Remediation if appropriate

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Objectives

Upon the completion this ACLS course the learner will be able to:

♥♥♥♥♥♥♥♥ Simulate a team leader and a team member

♥♥♥♥♥♥♥♥ Simulate airway management

♥♥♥♥♥♥♥♥ Verbalize the steps to assist in intubation

♥♥♥♥♥♥♥♥ Verbalize 5 steps in confirming ET tube placement

♥♥♥♥♥♥♥♥ Verbalize the definition of ROCS

♥♥♥♥♥♥♥♥ Verbalize the H’s and T’s with the signs and symptoms

and interventions

♥♥♥♥♥♥♥♥ Verbalize the four interventions for Bradycardia

♥♥♥♥♥♥♥♥ Verbalize the technique of managing the pacemaker

♥♥♥♥♥♥♥♥ Discuss an unstable tachycardia and the steps in cardioversion

♥♥♥♥♥♥♥♥ Discuss a stable tachycardia and appropriate drug interventions

♥♥♥♥♥♥♥♥ Verbalize the time frame required to initiate stroke

interventions

♥♥♥♥♥♥♥♥ Discuss the signs and symptoms of ACS and interventions

♥♥♥♥♥♥♥♥ Discuss the signs and symptoms of acute stroke and interventions.

♥♥♥♥♥♥♥♥ Discuss therapeutic hypothermia

Upon completion of the ACLS course the learner will be able to recognize and

select appropriate drugs for the following rhythms:

♥♥♥♥♥♥♥♥ Ventricular Fibrillation

♥♥♥♥♥♥♥♥ PEA

♥♥♥♥♥♥♥♥ Asystole

♥♥♥♥♥♥♥♥ Supraventricular Tachycardia

♥♥♥♥♥♥♥♥ Rapid Atrial Fibrillation

♥♥♥♥♥♥♥♥ Torsades de Pointes

♥♥♥♥♥♥♥♥ Bradycardia

♥♥♥♥♥♥♥♥ 1st, 2

nd, 3

rd Degree Blocks

♥♥♥♥♥♥♥♥ Paced rhythm

Upon completion of this ACLS course the learner will be able to

♥♥♥♥♥♥♥♥ Demonstrate BLS with the AED

♥♥♥♥♥♥♥♥ Demonstrate Respiratory Management with a pulse

♥♥♥♥♥♥♥♥ Demonstrate Respiratory Management without a pulse

♥♥♥♥♥♥♥♥ Demonstrate interventions of Bradycardia – VF – Asystole

♥♥♥♥♥♥♥♥ Demonstrate intervention of Unstable Tachycardia – VF – PEA – ROSC

♥♥♥♥♥♥♥♥ Demonstrate intervention of Stable Tachycardia – VF – PEA – ROSC

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.The Electrical Impulse

When the electricity goes through the heart it travels from the

SA node to the AV node. As that occurs it causes the atrium to contract

and a P wave appears on the EKG paper. When the electricity travels on

through the Bundle Branches it causes the ventricles to contract and the

QRS complex appears. When the heart goes through its resting phase the

T wave appears. If you have a P wave, QRS complex, and a T wave –

you have a Sinus Rhythm.

A Q wave is an abnormal wave and should not

appear. It is a downward deflection in the QRS complex.

It indicates an infarction has or is occurring.

To determine the age of the infarction we must examine the

“isoelectric line.” The isoelectric line should be level as it is seen in

the tracing on the following page. The dark heavy line that enters

the QRS complex is at the same level that comes out of the QRS

complex. This line may come out of the QRS complex “elevated” or

“depressed.” Note the elevation in the above complex. Examine the

12-lead EKG on page 6. Note the elevation in Lead I and Lead

AVL. Note the depression in V3 and V4.

Q waves with ST segment elevation may indicate an ST

segment elevated myocardial infarction (STEMI) and rapid and early

reperfusion is essential for optimal outcome

There are several ways to determine the rate of the rhythm. Your

NEO instructor will show you the following way in class. Memorize the

numbers in red on the next page. You may want to memorize them in

groups of three. (300-150-100) (75-60-50) Then find a complex that

lands on a bold line. Go to the next bold line and say “300,” then “150,”

then “100,” then “75,” then “60.” The second complex landed between

60 and 75. In resuscitation. Approximate rates are all that you need to

know.

The following rhythm is a sinus rhythm with a rate 60-75 bpm.

There is no Q wave. The isoelectric line is level. The T wave is upright.

5

`

P WaveP WaveP WaveP Wave

Originates in the SA

Node

PPPP----R IntervalR IntervalR IntervalR Interval

0.12 - 0.20

Beginning of the P to the

beginning of the R

QRS ComplexQRS ComplexQRS ComplexQRS Complex

Beginning of the Q

to the end of the S

ST segmentST segmentST segmentST segment

End of the S

To the beginning of the T

Note: Depression or Elevation

T WaveT WaveT WaveT Wave

QT intervalQT intervalQT intervalQT interval

Beginning of the Q

To the end of the T

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12-Lead EKG

Q = Infarction

ST (depression = ischemia)

(elevation = acuteness)

T inversion = Ischemia

Q waves with ST segment elevation may indicate an ST segment

elevated myocardial infarction (STEMI) and rapid and early reperfusion

is essential for optimal outcome.