Contents 1 Components of ALS 2 2010 changes 3 ALS algorithms 4 Hs and Ts 5 Other conditions 6 Who performs ALS 7 References 8 External links

Components of ALS[edit] A HSE advanced paramedic vehicle, at Aviva Stadium, Dublin, Ireland These include: Tracheal intubation Rapid sequence induction Cardiac monitoring Cardiac defibrillation Transcutaneous pacing Intravenous cannulation (IV) Intraosseous (IO) access and intraosseous infusion Surgical cricothyrotomy Needle cricothyrotomy Needle decompression of tension pneumothorax Advanced medication administration through parenteral and enteral routes (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)

2010 changes[edit] ALS is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems, as agreed in Europe by the European Resuscitation Council, most recently in 2010. 2010 revisions include: greater emphasis on continuous (uninterrupted) chest compression less emphasis on airway and breathing promotion of the intraosseous infusion of drugs and fluids if IV access not readily available further demotion of the precordial thump ongoing simplification expanded role for post-arrest hypothermia and emphasis on post-arrest normo-glycaemial maintenance.

ALS algorithms[edit] ALS assumes that basic life support (bag-mask administration of oxygen and chest compressions) are administered. The main algorithm of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation is applied, and medication is administered. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effect of the treatment on the heart rhythm, as well as the presence of cardiac output, is assessed. Medication that may be administered may include adrenaline (epinephrine), amiodarone, atropine, bicarbonate, calcium, potassium and magnesium. Saline or colloids may be administered to increase the circulating volume. While CPR is given (either manually, or through automated equipment such as AutoPulse), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as "6Hs & 5Ts" according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS).[1][2][3][4] 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[edit] Main article: Hs and Ts 'H's Hypoxia: low oxygen levels in the blood 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) Hypoglycemia: Low blood glucose levels '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, Advanced Cardiac Life Support guidelines have changed significantly. A major new worldwide consensus has been sought based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30:2 for adults, to produce higher coronary and cerebral perfusion pressures. Defibrillation is now administered as a single shock, each followed immediately by two minutes of CPR before rhythm is re-assessed (five cycles of CPR).

Other conditions[edit] ALS also covers various conditions related to cardiac arrest, such as cardiac arrhythmias (atrial fibrillation, ventricular tachycardia), poisoning and effectively all conditions that may lead to cardiac arrest if untreated, apart from the truly surgical emergencies (which are covered by Advanced Trauma Life Support).

Who performs ALS[edit] Many healthcare providers are trained to administer some form of ALS. In out-of-hospital settings trained emergency medical technicians, paramedics or medics typically provide this level of care. Canadian paramedics may be certified in either ALS (Advance Care Paramedic-ACP) or in Basic Life Support (Primary Care Paramedic-PCP) (see paramedics in Canada). Emergency medical technicians (EMTs) are often skilled in ALS, although they may employ 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), as those staffed by EMT-Intermediates are called Intermediate Life Support (ILS). 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. This terminology extends beyond emergency cardiac care to describe all 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 USA, generally include doctors and senior nurses from various specialties such as emergency medicine, anesthetics, general or internal medicine.

References[edit] ^ Part 7.2: Management of Cardiac Arrest - 112 (24 Supplement): IV-58 - Circulation ^ ACLS: Principles and Practice. p. 71–87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2. ^ ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. 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[edit] Adult advanced life support on UK Resuscitation Council website v t e Emergency medical services Paramedicine Basic life support Advanced life support People Certified first responder (CFR) Combat medic Emergency medical dispatcher (EMD) Emergency medical responder (EMR) Emergency medical technician (EMT) Advanced Emergency Medical Technician (AEMT) Paramedic Medical director Vehicles Air medical services Ambulance history Ambulance bus Blood bike Combination car Light horse field ambulance Motorcycle ambulance Nontransporting EMS vehicle Water ambulance Casualty lifting and movement Kendrick Extrication Device Litter Spinal board Scoop stretcher Spinal precautions Stretcher Vacuum mattress Weevac 6 Other Ambulance station Rescue squad Search and rescue Related fields Aviation medicine Diving medicine Emergency medicine Military medicine Wilderness medicine Retrieved from "" Categories: Emergency medicineMedical credentialsHidden categories: Webarchive template wayback links

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EnlargePalm Beach County Fire-RescueEmergency Medical ServicesPalm Beach County, FloridaBasic Life SupportEnlargeHSE National Ambulance ServiceAviva StadiumDublin, IrelandTracheal IntubationRapid Sequence InductionCardiacCardiac DefibrillationTranscutaneous PacingIntravenous CannulationIntraosseous InfusionCricothyrotomyNeedle CricothyrotomyTension PneumothoraxMedicationParenteralEnteralAdvanced Cardiac Life SupportPediatric Advanced Life SupportPre-Hospital Trauma Life SupportCardiopulmonary ResuscitationCardiac ArrestEuropean Resuscitation CouncilIntraosseous InfusionPrecordial ThumpBasic Life SupportOxygenAlgorithmCardiac ArrestElectrical ActivityHeartCardiac ArrhythmiaDefibrillationMedicationOxygenEndotracheal IntubationCardiac OutputAdrenalineEpinephrineAmiodaroneAtropineBicarbonateCalcium In BiologyPotassiumMagnesiumSaline (medicine)ColloidsAutoPulseAdvanced Cardiac Life SupportHs And TsHypoxia (medical)HypovolemiaVasodilationHyperkalemiaHypokalemiaPotassiumCalcium In BiologyMagnesiumHypothermiaHyperthermiaHydrogenAcidosisHypoglycemiaTension PneumothoraxCardiac TamponadePericardiumHeartPoisonMedicationPulmonary EmbolismThrombusAdvanced Cardiac Life SupportDefibrillationCPRCardiac ArrhythmiaAtrial FibrillationVentricular TachycardiaPoisonSurgical EmergencyAdvanced Trauma Life SupportHealthcare ProviderEmergency Medical TechnicianParamedicMedicBasic Life SupportParamedics In CanadaEmergency Medical TechnicianMedical AlgorithmUnited StatesBasic Life SupportEmergency Medical TechnicianIntermediate Life SupportRepublic Of IrelandRepublic Of IrelandPHECCEmergency MedicineAnestheticsGeneral MedicineInternal MedicineInternational Standard Book NumberSpecial:BookSources/0-87493-341-2International Standard Book NumberSpecial:BookSources/0-87493-424-9Wayback MachineTemplate:Emergency Medical ServicesTemplate Talk:Emergency Medical ServicesEmergency Medical ServicesParamedicineBasic Life SupportEmergency Medical ResponderCertified First ResponderCombat MedicEmergency Medical DispatcherEmergency Medical ResponderEmergency Medical TechnicianAdvanced Emergency Medical TechnicianParamedicMedical DirectorAir Medical ServicesAmbulanceHistory Of The AmbulanceAmbulance BusBlood BikeCombination CarLight Horse Field AmbulanceMotorcycle AmbulanceNontransporting EMS VehicleWater AmbulanceCasualty LiftingCasualty MovementKendrick Extrication DeviceLitter (rescue Basket)Spinal BoardScoop StretcherSpinal PrecautionsStretcherVacuum MattressWeevac 6Ambulance StationRescue SquadSearch And RescueAviation MedicineDiving MedicineEmergency MedicineMilitary MedicineWilderness Medicine (practice)Help:CategoryCategory:Emergency MedicineCategory:Medical CredentialsCategory:Webarchive Template Wayback LinksDiscussion About Edits From This IP Address [n]A List Of Edits Made From This IP Address [y]View The Content Page [c]Discussion About The Content Page [t]Edit This Page [e]Visit The Main Page [z]Guides To Browsing WikipediaFeatured Content – The Best Of WikipediaFind Background Information On Current EventsLoad A Random Article [x]Guidance On How To Use And Edit WikipediaFind Out About WikipediaAbout The Project, What You Can Do, Where To Find ThingsA List Of Recent Changes In The Wiki [r]List Of All English Wikipedia Pages Containing Links To This Page [j]Recent Changes In Pages Linked From This Page [k]Upload Files [u]A List Of All Special Pages [q]Wikipedia:AboutWikipedia:General Disclaimer

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