Advanced life support
Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).
Components
Key aspects of ALS level care include:
- Tracheal intubation
- Rapid sequence induction
- ECG
- Cardioversion and defibrillation using a manual or automated external defibrillator
- Transcutaneous pacing
- Ultrasonography
- Intravenous cannulation(IV)
- Intraosseous (IO) access and intraosseous infusion
- Surgical cricothyrotomy
- Needle cricothyrotomy
- Needle or finger tension pneumothorax
- Pericardiocentesis
- Advanced enteralroutes (IV, IO, PO, PR, ET, SL, topical, and transdermal)
- Advanced cardiac life support (ACLS)
- Pediatric Advanced Life Support(PALS) or Pediatric Education for Pre-Hospital Providers (PEPP)
- Pre-Hospital Trauma Life Support(PHTLS), Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS)
Algorithms
In cases of cardiac arrest, ALS builds on the foundations of basic life support (BLS) interventions such as bag-mask ventilation with high-flow oxygen, chest compressions, and use of an AED.
The core
Medications that may be administered include
While CPR is performed (which may involve either manual chest compressions or the use of automated equipment such as the
Note these reversible causes are usually taught and remembered as 4Hs and 4Ts[5]—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation.Hs and Ts
- 'H's
- Hypoxia: low oxygen levels in the body's tissues
- Hypovolemia: low amount of circulating blood, either absolutely due to blood loss or relatively due to vasodilation
- Hyperkalemia or hypokalemia: disturbances in the level of potassium in the blood, and related disturbances of calcium or magnesium levels.
- Hypothermia/Hyperthermia: body temperature not maintained
- Hydrogen ions (Acidosis)
- 'T's
- Tension pneumothorax: increased pressure in the thoracic cavity, leading to decreased venous return to the heart
- Tamponade: fluid or blood in the pericardium, compressing the heart
- Toxic and/or therapeutic: chemicals, whether medication or poisoning
- Thromboembolism and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a blood clot or other material)
As of December 2005,
Other conditions
ALS also covers various conditions related to cardiac arrest, such as
ALS providers
Many emergency
In out-of-hospital settings, trained paramedics and some specifically trained emergency medical technicians typically provide this level of care. Canadian paramedics may be certified in either ALS (Advanced Care Paramedic-ACP) or in basic life support (Primary Care Paramedic-PCP). Some Primary Care Paramedics are also trained in intravenous cannulation, and are referred to as PCP-IV (see paramedics in Canada). Emergency medical technicians (EMTs) are often skilled in ALS, although they may employ a slightly modified version of the medical algorithm. In the United States, Paramedic level services are referred to as advanced life Support (ALS). Services staffed by basic EMTs are referred to as basic life support (BLS). Services staffed by advanced emergency medical technicians can be called limited advanced life support (LALS), Intermediate Life Support (ILS), or simply advanced life support (ALS), depending on the State. In the Republic of Ireland, advanced life support (ALS) is provided by an advanced paramedic. Advanced Paramedic (AP) is the highest clinical level (level 6) in pre-hospital care in the Republic of Ireland based on the standards set down by PHECC, the Irish regulatory body for pre-hospital care and ambulance services. In the United Kingdom paramedics are registered healthcare professionals with the Health and Care Professions Council and are qualified to ALS level. This terminology extends beyond emergency cardiac care to describe all of the capabilities of the providers.
In hospitals, ALS is usually given by a team of doctors and nurses, with some clinical paramedics practicing in certain systems. Cardiac arrest teams, or "Code Teams" in the US, generally include doctors and senior nurses from various specialties such as
References
- ^ "Part 7.2: Management of Cardiac Arrest - 112 (24 Supplement): IV-58 - Circulation". Archived from the original on 2009-04-21. Retrieved 2008-07-15.
- ISBN 0-87493-341-2.
- ISBN 0-87493-424-9.
- ^ "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." Circulation 2005; 112: IV-58 – IV-66.
- ^ Resuscitation Council UK adult ALS algorithm 2005 Archived October 8, 2007, at the Wayback Machine
External links
- Adult advanced life support on UK Resuscitation Council website