Advanced Life Support (ALS) or Advanced Cardiac Life Support (ACLS) is a treatment algorithm followed by healthcare professionals when a situation arises requiring cardiopulmonary resuscitation (CPR) in cases of cardiac arrest, arrhythmias, stroke, or other related medical problems like poisoning. Advanced Life Support consists of CPR administration using oxygen administration via a bag or mask and chest compressions (see CPR Guidelines Poster), which are now recommended at a 30:2 ratio of compressions to ventilations for adults, children, and infants to produce higher coronary and cerebral perfusion pressures. The electrical activity of the heart is monitored and depending on the type of cardiac arrhythmia, defibrillation is applied, and medications such as adrenaline (epinephrine), amiodarone, or atropine are administered. Saline or colloids may also be given intravenously to increase the circulating fluid volume in the body. End tracheal intubation may also be necessary to secure the airway in some cases, see CPR guidelines chart.
While performing CPR, members of the Advanced Life Support team consider eight forms of potentially reversible causes of cardiac arrest, also known as “4H4T” as seen on the AED CPR guidelines reference poster. The “H’s” are hypoxia (low blood oxygen), hypovolemia (low blood volume), hyper/hypokalemia (high/low blood potassium), hypothermia (body temperature well below normal), followed by the “T’s” which include tension pneumothorax (tear in the lung leading to collapsed lung and distortion of major arteries), tamponade (fluid or blood in the pericardium compressing the heart), toxic and/or therapeutic chemicals or medications, or thromboembolism (blood clot in the heart or lungs). Early intervention, early access, early CPR, early defibrillation, and early advanced life support save lives. This team of medical professionals consists of physicians from all disciplines, anesthesiologists, emergency medical technicians, and others trained in ALS designated to respond in a cardiac emergency.
Pediatric Advanced Life Support (PALS) is very much like ALS only it is designed to aid the pediatric healthcare provider in recognizing and managing critically ill infants and children at risk for cardiopulmonary arrest. There are medical emergencies specific to this age group, and the focus is placed on early recognition of distress as related to a specific medical diagnosis. ALS and PALS training is provided to healthcare professionals that work with adults and children, including physicians, physician assistants, nurses, nurse practitioners, paramedics, and respiratory therapists, across the country by the American Heart Association. Just visit www.americanheart.org or www.heart.org for further discussion on new recommendations and all aspects of assessment and treatment of victims of respiratory and/or cardiac emergencies and stroke, including basic and advanced life support interventions.