ACLS_Handbook
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ACLS_Handbook

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Advanced Cardiac 
Life Support Provider Handbook
Presented by the: 
By Dr. Karl Disque
ACLS
2015
- 2020 
Guidelines and 
Standards
Copyright © 2020 Satori Continuum Publishing
All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication 
can be reproduced, distributed, or transmitted in any form or by any means, or stored in a database 
or retrieval system, without the prior consent of the publisher. 
Satori Continuum Publishing 
1810 E Sahara Ave. Suite 1507 
Las Vegas, NV 89104
Printed in the United States of America
Educational Service Disclaimer
This Provider Handbook is an educational service provided by Satori Continuum Publishing. Use of this 
service is governed by the terms and conditions provided below. Please read the statements below 
carefully before accessing or using the service. By accessing or using this service, you agree to be bound 
by all of the terms and conditions herein. 
The material contained in this Provider Handbook does not contain standards that are intended to be 
applied rigidly and explicitly followed in all cases. A health care professional\u2019s judgment must remain 
central to the selection of diagnostic tests and therapy options of a specific patient\u2019s medical condition. 
Ultimately, all liability associated with the utilization of any of the information presented here rests solely 
and completely with the health care provider utilizing the service.
Version 2020.01
Introduction to ACLS . . . . . . . 5
The Initial Assessment . . . . . . . 6
Basic Life Support . . . . . . . 7
Initiating the Chain of Survival \u2013 7
2015 BLS Guideline Changes \u2013 8
2010 BLS Guideline Changes \u2013 9
BLS for Adults \u2013 10
One-Rescuer Adult BLS/CPR
Two-Rescuer Adult BLS/CPR
Adult Mouth-to-Mask Ventilation
Adult Bag-Mask Ventilation in Two-Rescuer CPR
Self-Assessment for BLS \u2013 16
Advanced Cardiac Life Support . . . . . . . 18
Normal Heart Anatomy and Physiology \u2013 18
The ACLS Survey (ABCD) \u2013 19
Airway Management \u2013 20
Basic Airway Adjuncts
Basic Airway Technique
Advanced Airway Adjuncts
Routes of Access \u2013 24
Intravenous Route
Intraosseous Route
Pharmacological Tools \u2013 25
Self-Assessment for ACLS \u2013 26
Principles of Early Defibrillation . . . . . . . 27
Keys to Using an Automated External Defibrillator \u2013 28
Criteria to Apply AED
Basic AED Operation
Systems of Care . . . . . . . 30
Cardiopulmonary Resuscitation \u2013 31
Initiating the Chain of Survival
Post-Cardiac Arrest Care \u2013 32
Therapeutic Hypothermia
Optimization of Hemodynamics and Ventilation
Percutaneous Coronary Intervention
Neurologic Care
Acute Coronary Syndrome \u2013 33
Goals of ACS Treatment
Acute Stroke \u2013 34
Goals of Acute Ischemic Stroke Care
The Resuscitation Team \u2013 35
Education, Implementation, Teams \u2013 36
Self-Assessment for Systems of Care \u2013 37
Chapter
 1 
2 
3 
4 
5
6
TABLE of CONTENTS
ACLS Cases . . . . . . . 38
Respiratory Arrest \u2013 38
Ventricular Fibrillation and Pulseless Ventricular Tachycardia \u2013 42
Pulseless Electrical Activity and Asystole \u2013 44
Post-Cardiac Arrest Care \u2013 48
Blood Pressure Support and Vasopressors
Hypothermia
Symptomatic Bradycardia \u2013 51
Tachycardia \u2013 54
Symptomatic Tachycardia with Heart Rate Greater than 100 BPM
Stable and Unstable Tachycardia
Acute Coronary Syndrome \u2013 58
Acute Stroke \u2013 60
Self-Assessment for ACLS Cases \u2013 64
ACLS Essentials . . . . . . . 67
Additional Tools . . . . . . . 68
MediCode \u2013 68
CertAlert+ \u2013 68
ACLS Review Questions . . . . . . . 69
Chapter
 7 
8
9
10
TABLE of CONTENTS
The goal of Advanced Cardiovascular Life Support (ACLS) is to achieve the best possible outcome 
for individuals who are experiencing a life-threatening event. ACLS is a series of evidence-based 
responses simple enough to be committed to memory and recalled under moments of stress. These 
ACLS protocols have been developed through research, patient case studies, clinical studies, and 
opinions of experts in the field. The gold standard in the United States and other countries is the 
course curriculum published by the International Liaison Committee on Resuscitation (ILCOR). 
Previously, the ILCOR published periodic updates to their Cardiopulmonary Resuscitation (CPR) 
and Emergency Cardiovascular Care (ECC) guidelines on a five-year cycle, with the most recent 
update published in 2015. Moving forward, the ILCOR will no longer wait five years between updates; 
instead, it will maintain the most up-to-date recommendations online at ECCguidelines.heart.org. 
Health care providers are recommended to supplement the materials presented in this handbook 
with the guidelines published by the ILCOR and refer to the most current interventions and 
rationales throughout their study of ACLS.
Refer to the Basic Life Support (BLS) Provider Handbook, also Present-
ed by the Save a Life Initiative, for a more comprehensive review of the 
BLS Survey. This handbook specifically covers ACLS algorithms and only 
briefly describes BLS. All ACLS providers are presumed capable of per-
forming BLS correctly. While this handbook covers BLS basics, it 
is essential that ACLS providers be proficient in BLS first. 
While ACLS providers should always be mindful of timeliness, it is important to provide the 
intervention that most appropriately fits the needs of the individual. Proper utilization of ACLS 
requires rapid and accurate assessment of the individual\u2019s condition. This not only applies to the 
provider\u2019s initial assessment of an individual in distress, but also to the reassessment throughout the 
course of treatment with ACLS.
ACLS protocols assume that the provider may not have all of the information needed from the 
individual or all of the resources needed to properly use ACLS in all cases. For example, if a provider 
is utilizing ACLS on the side of the road, they will not have access to sophisticated devices to measure 
breathing or arterial blood pressure. Nevertheless, in such situations, ACLS providers have the 
framework to provide the best possible care in the given circumstances. ACLS algorithms are based 
on past performances and result in similar life-threatening cases and are intended to achieve the best 
possible outcome for the individual during emergencies. The foundation of all algorithms involves 
the systematic approach of the BLS Survey and the ACLS Survey (using steps ABCD) that you will find 
later in this handbook.
5
INTRODUCTION 
TO ACLS
ACLS \u2013 Advanced Cardiac Life Support
1
 Take Note
 Take Note
3
6 ACLS \u2013 Advanced Cardiac Life Support
THE INITIAL 
ASSESSMENT2
Determining whether an individual is conscious or unconscious can be done very quickly. If you 
notice someone in distress, lying down in a public place, or possibly injured, call out to them. 
\u2022 Make sure the scene is safe before approaching the individual and 
conducting the BLS or ACLS Survey. 
\u2022 When encountering an individual who is \u201cdown,\u201d the first assessment to 
make is whether they are conscious or unconscious.
If the individual is unconscious, then start with the BLS Survey and move on to the ACLS Survey. 
If they are conscious, then start with the ACLS Survey. 
>> Next: Basic Life Support
3
The ILCOR has updated the Basic Life Support (BLS) course over the years as new research in cardiac 
care has become available. Cardiac arrest continues to be a leading cause of death in the United 
States. BLS guidelines have changed dramatically, and the elements of BLS continue to be some of 
the most important steps in initial treatment. General concepts of BLS include: 
\u2022 Quickly starting the Chain of Survival.
\u2022 Delivering high-quality chest compressions for adults, children, and infants. 
\u2022 Knowing where to locate and understanding how to use an 
 Automatic External Defibrillator (AED)
\u2022 Providing rescue breathing when appropriate. 
\u2022 Understanding how to perform as a team. 
\u2022 Knowing how to treat choking. 
 
INITIATING THE CHAIN OF SURVIVAL 
Early initiation of BLS has been shown to increase the probability