Note: Your progress in watching these videos WILL NOT be tracked. These training videos are the same videos you will experience when you take the full ProACLS Recertification program. You may begin the training for free at any time to start officially tracking your progress toward your certificate of completion.
In this section of your ACLS course, we're going to look at the current ACLS pharmacological treatments, including some important things to keep in mind as you progress through this section of your course. At the end of the lesson, we'll look at the finer points of resuming CPR while a defibrillator is charging.
It's important to remember that no medication will work the way you expect it to or want it to unless the patient's biological status, at the cellular level, works the way you want it to or expect it to.
What do we mean by this? We know that there has been a lot of research done that better helps us understand that when a patient is in cardiac arrest, at the cellular level they have a very specific amount of time before clinical death transitions into biological or cellular death. In other words, permanent death.
As cellular hypoxia progresses into cellular death, the body's ability to react to treatments, including the medications we'll be covering in this section, become much more difficult and much more unlikely.
For this reason, it's vitally important that, as a healthcare professional, you are able to provide highly effective basic life support skills. These are foundational skills and extremely important for any and all successful ACLS outcomes.
ACLS Medications
The variety of medications that we'll cover in this section of the course are only one part of any successful resuscitation (and one part of the chain of survival) and will include:
- Adenosine
- Amiodarone
- Aspirin
- Atropine
- Dopamine
- Epinephrine
- Fibrinolytic Agents
- Lidocaine
- Magnesium sulfate
- Morphine sulfate
- Nitroglycerin
- Oxygen
- Procainamide
The ACLS Chain of Survival
Essentially, basic life support helps the patient by buying them time. Time it takes the body to transition from clinical death to biological, cellular, and permanent death.
The ACLS medications listed above that we'll be digging into in subsequent lessons are just one small part of any successful resuscitation. ACLS is the next level in the chain of survival that includes four main components:
- The administration of medications
- EKG and ECG monitoring
- Advanced airways
- Other treatment options
Your goal is to help keep the patient in a state of survivability until, ultimately, you're able to get them appropriate and definitive treatment that will hopefully and ideally reverse their life-threatening condition.
The Administration of Medications
As you begin to learn about, or refresh your knowledge of, these current ACLS medications, we'll be breaking down each into four distinct categories:
- The drug and its effects
- The drug's indications
- The drug's precautions and contraindications
- The drug's appropriate dosage
A Word About Resuming CPR While the Defibrillator is Charging
It's important to continue to perform high-quality CPR until a defibrillator arrives and is attached to the patient. The team should assign team member roles and responsibilities as well as organize the appropriate interventions to minimize interruptions in chest compressions.
Doing so accomplishes the most critical interventions for VFib or pulseless V-tach – CPR with minimal interruptions in chest compressions and defibrillation during the first minutes of arrest.
The American Heart Association does not recommend continued use of an AED (or the automatic mode) when a manual defibrillator is available and when the healthcare provider's skills are sufficient for rhythm interpretation. The reasons is simple – rhythm analysis and shock administration with an AED may result in prolonged interruptions in chest compressions.
Shortening the interval between the last chest compression and the ensuing shock by even a few seconds can help improve shock success. Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock.
For example, after verifying that the patient has a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue performing them until the defibrillator is fully charged.
The operator of the defibrillator should deliver the shock as soon as the compressor removes his or her hands from the patient's chest and after all providers are clear of contact with the patient.
Use of a multimodal defibrillator in manual mode can help reduce the duration of chest compression interruptions that are required for rhythm analysis when compared to automatic mode. However, this could increase the frequency of inappropriate shocks. Individuals who are not comfortable interpreting cardiac rhythms can and should continue to use an AED.
When using an AED, follow the device's prompts or know your device-specific manufacturer's recommendations. It's important that all healthcare providers be knowledgeable of how their defibrillator works, and whenever possible, limit interruptions in chest compressions for rhythm analysis and shock delivery.
