ACLS

This application uses a variety of randomly assigned patients that present with the ACLS core rhythms.

App Objectives

Non-Cardiac Arrest

1. Recognition of unstable, which informs management of the non-arrest patient:

• Hypotension
• Altered mental status
• Signs of shock
• Chest discomfort
• Heart failure

2. Manage the following rhythms in a stable patient:

• SVT (AVNRT)
• Sinus Tachycardia
• Sinus Bradycardia
• 2nd Degree AV Block – Type 1 (Wenckebach)

3. Manage the following rhythms in an unstable patient:

• Atrial Fibrillation with RVR
• Atrial Flutter
• Sinus Bradycardia
• Ventricular Tachycardia
• AV Block

Cardiac Arrest

1. Situational awareness of the patient’s condition

• Rhythm checks
• Return of spontaneous circulation (ROSC)
• Perfusion

2. High quality chest compressions

• Immediate commencement of chest compressions if presence of a pulse is not certain
• Rate not to fall below 100 bpm
• EtCO2>10 (failure to achieve may be caused by inadequate rate as above of depth of compression <2 inches)
• Swap compressors every 2 minutes or when signs of fatigue are identified (as indicated by a and c above)
• CCF at least 80% and pauses not to exceed 10 seconds – not in V1

3. Avoid excessive ventilation

• Ventilation not to exceed 10-12 breaths per minute

4. Obtain intraosseous access when peripheral accessis not readily attainable

5. General, Personal & Team Protection

• Understanding PPE selection and proper donning/doffing for aerosolized pathogens
• Developing situational awareness, as a PPE observer, for breaches during donning, intra-resuscitation, and doffing
• Limiting the number of providers during aerosolizing procedures (i.e., intubation, pre-intubated CPR)
• Developing reflex communication of pathogen status to any new providers entering the room

6. Airway and Ventilation:

• Understanding and employing the oxygenation & ventilation strategies that pose lower risk for aerosolization.
• Ensuring that a HEPA filter is attached to the BVM
• Intubating as early as possible in cardiac arrest (with a cuffed tube)

7. Compressions:

• Limiting the number of compressors by using a mechanical CPR device where appropriate
• Possible learning objective for prone CPR in prone-vented patients with cardiac arrest

8. Management of the following rhythms:

• Ventricular Fibrillation
• Ventricular Tachycardia
• Pulseless Ventricular Tachycardia
• Asystole

9. Awareness of initiating post-arrest cooling protocol