Advanced cardiac life support (ACLS)
Advanced Cardiac Life Support (ACLS) is a crucial set of medical procedures designed to assist individuals experiencing life-threatening emergencies such as heart attacks and strokes. This advanced intervention goes beyond basic life-saving techniques like CPR and Basic Life Support (BLS) by incorporating sophisticated technologies and clinical interventions, including the use of drugs and advanced airway management. Typically performed by trained medical professionals—such as physicians, nurses, and paramedics—ACLS protocols are grounded in established algorithms that guide responders in quickly assessing patient conditions and determining appropriate treatments.
The origins of these techniques date back to the 18th century, evolving through historical milestones in resuscitation methods. ACLS training is rigorous, requiring participants to understand and interpret electrocardiograms (ECGs) to identify various cardiac rhythms and conditions. Regular updates to ACLS guidelines ensure that medical professionals remain informed about the latest advancements in technology and treatment methods. Research indicates that effective implementation of ACLS protocols can lead to significantly improved patient outcomes during critical events. This structured approach not only enhances the likelihood of patient survival but also emphasizes the importance of ongoing education and training for those involved in emergency medical care.
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Advanced cardiac life support (ACLS)
Advanced cardiac life support (ACLS) is a series of medical procedures used to assist someone who is having a heart attack, a stroke, or other life-threatening emergency. The steps used in ACLS include physical treatments such as establishing an airway to facilitate breathing. They also include clinical interventions such as the administration of oxygen or drugs to help stabilize the patient. Those who perform ACLS are almost always medical professionals because only they have access to the equipment and pharmaceuticals necessary for ACLS.
Background
People have tried to breathe life into the dying or recently dead since ancient times. However, the advanced techniques that are part of advanced cardiac life support (ACLS) have their origins in the eighteenth century. In the 1770s, the Society for the Recovery of Persons Apparently Drowned began the first organized attempts to establish techniques for dealing with life-threatening emergencies. This society evolved into the Humane Society in England and had some success with lifesaving measures including the use of electrostatic shocks to restore the heart to normal function.
The first fully documented attempt at chest compressions—the strong rhythmic pushes against the chest intended to help force blood through the circulatory system—occurred in 1891. American surgeon George Crile (1864–1943) was the first to use these compressions to save a life in 1903. A year later, Crile became the first American to attempt closed-chest cardiac massage, a more specific method of chest compressions aimed at restarting the heart.
In the 1960s, cardiopulmonary resuscitation (CPR) techniques were developed and promoted for use by both medical professionals and the general public. During the 1970s, medical professions tried to train as many people as possible to use this combination of chest compressions and breaths on unconscious persons. In 1979, the Third National Conference on CPR endorsed ACLS as set of procedures to be used by medical professionals to save the lives of those in cardiac arrest or other urgent conditions.
Overview
Advanced cardiac life support (ACLS) techniques are used by medical professionals to treat and stabilize a person having a heart attack, severe breathing difficulties, shock, and other conditions that threaten life. It is different from other lifesaving procedures such as cardiopulmonary resuscitation (CPR) and Basic Life Support (BLS) in that it uses more sophisticated techniques and equipment, which is usually only available to medical professionals such as physicians, nurses, nurse practitioners, physician's assistants, dentists, pharmacists, respiratory therapists, paramedics, and emergency medical technicians (EMTs).
These professionals receive special training in the procedures and techniques that are part of ACLS protocols. These protocols are reviewed and updated every five years to reflect new technology, techniques, drugs, and up-to-date research. Medical professionals must take training courses to become certified in ACLS and are also required to take regular refresher courses.
Those who undergo ACLS training have usually already been trained in BLS, which uses a set of guidelines called algorithms that allow the emergency responder to determine the most likely cause of the patient's condition and respond accordingly. Many emergency responders such as police officers, firefighters, lifeguards, and security guards are trained in BLS, as are others who may be called upon to help in an emergency. These include teachers, social workers, daycare workers, babysitters, and athletic trainers.
Like BLS, ACLS uses algorithms to help the emergency responder determine the potential cause of the patient's condition and decide on the most appropriate treatment. However, as the name implies, the algorithms and the steps to be taken are more advanced and use more sophisticated technology and tools, which is why only medical professionals undergo training to administer ACLS. They must learn to understand the readings of an electrocardiogram (ECG), a device that records a patient's heart rhythm, in order to determine which algorithm to follow for a patient's care. ACLS algorithms exist for a patient who has a slow heart rate, a fast heart rate, or no heart rate, as determined by the ECG. Medical professionals undergoing ACLS training are also tested on various scenarios, such as responding to a patient both in and out of a hospital setting, responding with others available to assist, and responding alone and/or with limited or no advanced equipment and pharmaceuticals.
ACLS algorithms are in flowchart formats, so the responder goes through the steps answering "yes/no" questions and following the appropriate alternative for each question to reach decisions about the potential cause and appropriate response. As the responder works through the algorithms, a variety of medical procedures may be required. These include CPR, the use of an automated external defibrillator (AED), the use of a manual defibrillator, intubation (inserting a tube to help air reach the lungs) and other ways to manage airways, the administration of oxygen and drugs, and the insertion and management of intravenous (IV) lines. The algorithms make it possible for the responder to do this quickly and efficiently. When a situation is encountered that is not addressed by a cause identified in the algorithms, the responder may still find a way to stabilize the patient so further tests and diagnosing can be done. In addition, knowing what has been eliminated as a potential cause can help a responder decide on the next course of action.
Studies have indicated that the use of ACLS techniques results in significantly better outcomes for patients. Experts say the procedures help because the algorithms allow medical professionals to more quickly recognize a patient's condition and its cause and institute treatment to stabilize. As a result, it is believed medical professionals who undergo thorough ACLS training and regular retraining will be able to help more patients survive these life-threatening events.
Bibliography
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