ADVANCE LIFE SUPPORT ADVANCE LIFE SUPPORT (ALS)(ALS)

Dr. Arif H.M.Marsaban, SpAnk

What is advance life support (ALS) ?What is advance life support (ALS) ?

It is the continuation of Basic Life support to help support the patient and ensure return of spontaneus circulation

BLS provides cardiac output of BLS provides cardiac output of only 25% normal & delivers 10% only 25% normal & delivers 10% oxygenoxygen

Produces limited circulation not Produces limited circulation not enough to support brain & heart for enough to support brain & heart for long long

WHAT STEPS OR THERAPIES WHAT STEPS OR THERAPIES ARE IN ALS ?ARE IN ALS ?

2 lines of steps or therapies 2 lines of steps or therapies in ALSin ALS

1. early & continued attempts at defibrillation

2. attemps to improve myocardial performance

How do we achieve How do we achieve this steps or therapiesthis steps or therapies

1. Rapid interventions2. Use of equipments

Steps or therapies in ALS :

What are the rapid What are the rapid interventionsinterventions

1.Defibrilation (or defib)2.advance airway care 3. Drugs therapy

What is What is defibrilationdefibrilation

1. Defibrillation

Defibrilation (or defib) is an attempt to stop ventricle fibrilation (VF) or pulseless ventricle tachycardia (VT)

How does defib. worksHow does defib. works

Defib uses direct current counter shock that produces simultaneous depalarization of the mass of myocardial cells and enables the resumption of organized electrical activity

Why is defib on important Why is defib on important early procedure ?early procedure ?

The majority of heart arrest due to coronary artery disease have VF or pulseless VT & defib. Is the effective therapy

What is meant What is meant by early procedureby early procedure

The benchmarks for timing of early defib.: Within 5 minutes of call for out-of

hospital arrest : Within 3 minutes of call in-hospital

arrest

If the rhythm is undetermined, or a delay in diagnosis , a blind shock should be delivered

How is defib done ?How is defib done ?

1. The paddles should be given gel.or lubricant as not to burn the skin

Place one paddle on the right parasternal & the other paddle on the apex of heart.

Initial energy charges to 200 J, that nobody has a contact with the patient or bed & then press tha charge

Check the rhythm,if VT/VF persist another 200 J or 300 J, if persit give a third shock of 360 J

After 3 shock, no response After 3 shock, no response than pharmacology therapy than pharmacology therapy necessarynecessary

Precaution in defib.Precaution in defib.

Charging the paddles in the airDefib over ECG electrodes,

nitrate patches or pace makersPhysical contact with patient

on bed

Failure of defib.Failure of defib.

Prolongned hypoxia or ischemiaEquipment failureHigh thoracic impedance

(Obesity)