AHA Advanced Cardiac Life Support (ACLS) 2020 Guidelines Course at Saving American Hearts 6165 Lehman Drive Suite 202 Colorado Springs, Colorado 80918

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ISBN # 978-1-61669-400-5 25
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AHA Advanced Cardiac Life Support (ACLS) 2020 Guidelines Course at Saving American Hearts 6165 Lehman Drive Suite 202 Colorado Springs, Colorado 80918. (INCLUDES 2020 Provider Manual and FREE BLS!)

*ACTION REQUIRED*

Please note, you are now required to take a 4 hour precourse test and watch the course videos online before attending the class. Take a picture of your certificate or bring it with you to class. Class will focus on the hands on teaching and testing portion of the class. The precourse work takes a solid 4 hours. Once you begin the first section of the online course, you must complete it in one sitting. The second portion includes all the course videos and can be broken up into 20 pieces if necessary. If you have any questions, please email Catherine Brinkley at admin@savingamericanhearts.com

AHA ACLS Advanced Cardiac Life Support Initial Certification is an advanced, instructor-led classroom course that highlights the importance of team dynamics and communication, systems of care and immediate post-cardiac-arrest care. Advanced Cardiovascular Life Support (ACLS) builds on the foundation of Basic Life Support (BLS), emphasizing the importance of continuous, high-quality CPR. The hands-on instruction and simulated cases in this advanced course are designed to help enhance their skills in the recognition and intervention of cardiopulmonary arrest immediate post-cardiac arrest, acute arrhythmia, stroke, and acute coronary syndromes. We will teach you all the information you need to successfully manage emergencies such as cardiac arrest, respiratory arrest, heart attack and stroke. This ACLS (Advanced Cardiac Life Support ) course is designed for healthcare providers who participate in resuscitation of patients in hospital, medical offices, or in settings where conscious sedation is administered and has not previously taken this course or one who has not taken it for over two years. It covers identification and treatment of patients with medical conditions who are at risk for cardiac arrest, primary and secondary assessment survey and actions needed, algorithms for treatment of emergency situations and effective resuscitation team dynamics. Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. Although arrhythmia recognition will be reviewed, it is expected that the participant will have a working knowledge of EKG rhythms. Practice with defibrillators and external pacemaker is included. Assessment and care for the patient experiencing an Acute Coronary Syndrome or Stroke will be included in this course.  Upon successful completion of the ACLS Provider course, students will be issued their AHA ACLS Provider Card via email within 12 to 24 hours. We structure this class to meet all of the AHA guidelines and requirements. All scenarios are designed for the work place of the individual participant. Our goal is that each participant will feel comfortable in handling life threatening emergencies in their own setting. You'll learn the 2020 ACLS Algorithms, drug dosages and usage, how to successfully perform cardioversion, defibrillate and perform external pacing as well as basic CPR, using a bag mask device and an AED. The course includes watching the Advanced Cardiac Life Support (ACLS) full course video, learning stations for Basic Life Support (BLS), CPR and the use of an AED. You will actively participate in the learning stations for the Advanced Cardiac Life Support (ACLS) algorithms, review of medications used in Advanced Cardiac Life Support, how to manage respiratory emergencies and insert and manage advanced airway devices. You will practice hands on techniques before taking the written exam and the hands on skills testing portion of the class. At the end of the class you will take a written test of 50 questions and successfully perform as a team leader in a case scenario. (You may be assigned an online 50 question test in stead of the traditional paper test. We are waiting on a response from AHA.

Skills to be practiced during the course include:

2020 BLS and ACLS Surveys

CPR Coach

Airway Management

Rhythm Recognition

Defibrillation

IV and Intraosseous Access

Use of Medications

Cardioversion

Transcutaneous Pacing

1-rescuer CPR and AED

Team Resuscitation Concept (Team Leader and Team Member)

Immediate Post-Cardiac Arrest Care

1-Rescuer CPR and AED use

Respiratory Arrest

Peri-arrest Rhythms (Tachycardia, Bradycardia)

Arrest Rhythms (VF, PVT, PEA, Asystole)

Acute Coronary Syndromes (ACS)

Stroke

The Pretest is now mandatory and can be found at www.elearning.heart.org. In the search bar at the top right of the screen type in ACLS Precourse. Make sure that you select this free course. You must log in or create an account to continue. This precourse work will now take a solid 4 hours to complete. You may just leave to do something else, and you can get right back to where you were if you are not in the testing area of the course. There are two parts, you can not stop during the first portion.

 

The Advanced Cardiovascular Life Support (ACLS) Precourse Self-Assessment evaluates a student’s knowledge before the course to evaluate proficiency and determine the need for additional review and practice. The ACLS Precourse Work involves a student reviewing course content through online videos before entering the classroom. The video lessons cover multiple medical subjects and each lesson includes questions to engage the student.

Learn More 
 

You must obtain a passing score of 70% or greater. The pretest is free and can be taken as many times as needed to pass. Print your scores for the Pre-course Self-Assessment and bring them with you to class. You may also text a picture of your certificate to Catherine Brinkley at (719) 551-1222.

What to Wear

Please wear loose, comfortable clothing to class. You will be practicing skills that require you to work on your hands and knees, and the course requires bending, standing, and lifting. If you have any physical condition that might prevent you from engaging in these activities, please tell an instructor. The instructor may be able to adjust the equipment if you have back, knee, or hip problems.

The course is taught in a STRESS FREE, FUN environment. I want you to leave class feeling like you're glad you came, you learned a lot and you ACTUALLY HAD FUN !!! You will MASTER all the skills you need to run a code and learn all the rhythms and drugs to treat them. IT'S A PIECE OF CAKE !!! STRESS FREE ! FUN !! If you have any questions about the course, please call Catherine Brinkley RN at (719) 551-1222.

 

SAVING AMERICAN HEARTS ADVANCED CARDIAC LIFE SUPPORT STUDY GUIDE AND ACLS SUPPLEMENTARY MATERIAL Based on the 2015 Guidelines of the American Heart Association

Always begin Basic Life Support with chest compressions, not breaths. Give 30 compressions and 2 breaths. 5 cycles of 30 compressions and 2 breaths = 2 minutes. Check for a pulse every 2 minutes, and switch providers every 2 minutes so that the person giving compressions does not get too tired. Good quality compressions must be given.

For adults, compress at least 2 inches or 5 cm. Always let the chest completely recoil. Provide at least 100 to 120 compressions per minute. Do not spend more than 10 seconds assessing the patient, or checking for a pulse. If you are unsure if they have a pulse, begin chest compressions. Keep interruptions in chest compressions to 10 seconds or less.

WAVEFORM CAPNOGRAPHY

Waveform capnography is written as PETCO2 (Patient End Tidal CO2) The normal is 35-40. If your PETCO2 number is less than 10, this indicates ineffective chest compressions. Waveform capnography is used to measure CPR quality and determine ROSC (Return of Spontaneous Circulation). Waveform capnography is the MOST reliable indicator of ETT placement. If the person doing the intubation happens to get the ETT into the esophagus vs the trachea, there would be no waveform capnography reading.

RESCUE BREATHING

When providing breaths, if doing compressions give 30 compressions and 2 breaths. Each breath should be given over 1 second, and only until you see the chest rise. Giving a bigger breath will only fill the stomach with air which will compress the diaphragm, chest and lungs making it difficult to resuscitate your patient.

If your patient has a pulse and simply cannot breath, provide breaths at a rate of 1 breath every 5-6 seconds = 10-12 breaths/min.

If your patient is intubated (has an advanced airway ), provide 1 breath every 6 seconds = 10/min.

When an advanced airway is in place, compressions should not be paused to give breaths.

 

GUIDELINES FOR SYNCHRONIZED CARDIOVERSION

 

UNSTABLE ATRIAL FIBRILATION

The initial BIPHASIC energy dose should be between 120-200 Joules

 

UNSTABLE SVT OR UNSTABLE ATRIAL FLUTTER   

The initial BIPHASIC energy dose should be between 50-100 Joules

 

RHYTHMS WITH MONOPHASIC WAVEFORMS

The initial MONOPHASIC or BIPHASIC energy dose should begin with 200 Joules and increase in a stepwise fashion if not successful

 

UNSTABLE MONOMORPHIC VT

The initial MONOPHASIC or BIPHASIC energy dose of 100 Joules If the initial shock fails, always increase the dose in a stepwise fashion.

 

THERAPUTIC HYPOTHERMIA

(The NEW 2015 Guidelines has renamed this "Targeted Temperature Management" Used only when your patient remains unresponsive following cardiac arrest, especially those who presented with an initial rhythm of v-fib. These patients are cooled to 32-36 degrees celsius for at lease 24 hours. If your patient wakes up and follow commands, do not start hypothermia protocol.

 

CHEST PAIN

Any patient having chest pain should have an EKG first. You must know if they are having a STEMI and will require transport to a hospital that has a cath lab. STEMI (ST segment elevation) must go to the cath lab for an angiogram or they will die. The heart muscle is not perfusing. NSTEMI (ST depression) usually are able to go home on blood thinners after a preventive angiogram, PCI or heart cath.

The only exception to the EKG first, is a patient where the chest pain is caused by their heart rate. If they are unstable, synchronized cardio version should be the first treatment. So, if an ambulance is bringing you a STEMI patient, and your facility does not have the capabilities to do a heart cath, or angiogram, these patients need to be diverted to a specialty cardiac hospital even if it’s an hour away. If you accept the patient, you then have to get admit orders, have consents signed, do the whole med rec and then get transfer orders, find an accepting doctor and transfer the patient anyway. The patient would be better off getting closer to the special hospital.

STROKE

The same goes for the stroke patients, if your hospital's CT scan is broken, you need to divert them as well. Anyone with stroke symptoms should have their blood sugar checked FIRST. Numerous people come to ER with decreased LOC, slumping to one side and slurred speech because they took their insulin this morning and haven’t eaten all day. Checking blood sugar is a really fast way to rule out a stroke. The SECOND thing you want to do is called a Cincinnati Pre-Hospital Stroke Assessment Scale. It's a very quick assessment Check for FACIAL DROOP, SLURRED SPEECH, and ARM DRIFT. The THIRD thing you need to do is get that CT SCAN. You need to know if they are having an ischemic stroke or a hemorrhagic stroke. If they are bleeding, they will not get the fibrinolytics.

Atropine is no longer used in the AYSTOLE/PEA Algorithm The American Heart Association defines PEA as sinus rhythm without a pulse. Atropine is the first line treatment for any bradycardia regardless of the type, a dopamine drip should be started at 2-10 mcg/kg/min if the rhythm is a 3rd degree block. Run the dopamine until pacing begins. The preferred method of epinephrine administration is via peripheral. During a code there is no time to obtain central venous access. When attempting IV access, peripheral access should be tried first, if that is unsuccessful move to I/O access. The recommended fluid bolus for a patient who achieves ROSC and is hypotensive is 1-2 Liters. You want to get a minimal SBP of at least 90 to ensure perfusion.

Once your patient achieves ROSC you need to make sure they are oxygenated and ventilated. This is now your first priority. Providing quality chest compressions immediately before a defibrillation attempt will improve successful conversion of V-Fib.

The American Heart Association says that it is acceptable to stop resuscitation efforts if the patient has not had a pulse for 15 consecutive minutes. Except in special cases of drowning or hypothermia.

Always be aware of safety hazards. Don't ever cut adult pads in half or shock a patient if there is oxygen blowing across their chest. The oxygen combined with the electric spark could cause a small explosion or ball of fire that injures everyone in the room. When possible, use the hands free pads. Paddles take much longer to deliver a shock because you must add the conduction jelly and after the shock is delivered, someone is stuck holding them. Always provide chest compressions while the defibrillator is charging. The time it takes to analyze is several seconds, you want to make the hands-off period of time as short as possible. Some defibrillators can take up to 45 seconds to charge. Remember when suctioning a patient, do not suction for longer than 10 seconds. Always make sure you have a 6 second rhythm strip if you are going to be counting the QRSs by 10 to get your heart rate. If you have a 12 second strip and do this you are likely to end up with a heart rate of 80 when it's actually only 40. The treatment is significantly different.

Always make sure the scene is safe before providing any help to someone. It would not do anyone any good if you ran out into the middle of the street to save someone and get hit by a car. Make sure You assess the scene for safety hazards first.

The initial priority for ANY tachycardia is do they have a pulse or not. The treatment for each is completely different. The only rhythm you will ever shock is V-Fib and pulseless V-Tach. The only rhythm you will ever cardiovert is an unstable tachycardia whether it's SVT or atrial does not matter.

Cricoid pressure is no longer recommended. It used to be done routinely, when providers were attempting to occlude the esophagus and prevent vomiting, however inexperienced providers were also unknowingly occluding their airway too. So It is not longer recommended.

If you have any questions please let me know. You can call Catherine Brinkley at (719) 551-1222 or email: admin@savingamericanhearts.com

Saving American Hearts, Inc 6165 Lehman Drive Suite 202 Colorado Springs, Colorado 80918