The Systematic Approach to ACLS
Foundational to every ACLS Algorithm is the BLS Assessment. The BLS Assessment is the first step that you will take when treating any emergency situation, and there are 4 main assessment steps to remember.
This is an outline of the 4 steps in the BLS Assessment :
(1) Check responsiveness by tapping and shouting, “Are you all right?” Scan the patient for absent or abnormal breathing (scan 5-10 seconds).
(2) Activate the emergency response system and obtain a AED. If there is more than one rescuer, have the second person activate emergency response and get the AED/Defibrillator.
(3) Circulation: Check for a carotid pulse. This pulse check should not take more than 5-10 seconds. If no pulse is palpable begin CPR.
(4) Defibrillation: If there is no pulse, check for a shockable rhythm with the AED or defibrillator as soon as it arrives. Follow the instructions provided by the AED or begin ACLS Protocol.
For a more in-depth review of BLS refer to the American Heart Association’s BLS Provider Manual.
Remember to assess first then perform appropriate actions, and after each action…reassess.
The Primary Assessment uses the ABCDE model to systematize the assessment process. The ABCDE’s of the Primary Assessment are:
(A) Airway: Maintain airway and use advanced airway if needed. Ensure confirmation of placement of an advanced airway and secure the advanced airway device.
(B) Breathing: Give bag-mask ventilation, provide supplemental oxygen, and avoid excessive ventilation. Also, adequacy of ventilation and oxygenation should be monitored during this step.
(C) Circulation: Obtain IV access, attach ECG leads, identify and monitor arrhythmias, giving fluids if needed, and use defibrillation if appropriate.
(D) Disability: Perform a general neurological assessment which should include assessment of responsiveness, level of consciousness, and pupil reflex. AVPU acronym may help. (Alert, Voice, Painful, Unresponsive)
(E)Exposure: Ensure that clothing is removed so that a complete visual assessment can be performed. This visual assessment should include looking for signs of trauma, bleeding, burns, or medical alert bracelets.
The Primary Assessment is included in every ACLS algorithm and like the BLS Assessment, it helps to systematize the resuscitation process and improve patient outcomes.
The secondary assessment includes a search for underlying causes for the emergency and if possible a focused medical history. This search for for underlying causes, also known as differential diagnosis, requires a review of all of the H’s and T’s of ACLS. Visit H’s and T’s page for a full review.
Performing the focused medical history can be simplified using the acronym SAMPLE. (S)Signs and symptoms; (A)Allergies; (M)Medications; (P)Past Illnesses; (L)Last Oral Intake; (E)Events Leading Up To Present Illness.
Use the links to the left for further details of ACLS Protocol and specific interventions in each ACLS algorithm.
The objective of the review of these ACLS Algorithms is to help prepare you for the ACLS written test and the ACLS Megacode. After reviewing, you can test your skills and knowledge by accessing the ACLS Megacode Simulator and ACLS practice exams.