Ethan Rhodes
Advanced Life Support (ALS) is a set of life-saving skills and protocols that extend beyond Basic Life Support (BLS) techniques. ALS focuses on providing constant, high-quality CPR, advanced airway management, IV access, medication administration, and advanced cardiac life support. It is performed by highly trained paramedics and other qualified healthcare professionals in both emergency and hospital settings. ALS covers various conditions related to cardiac arrest, such as cardiac arrhythmias, poisoning, and other conditions that may lead to cardiac arrest if untreated. Accredited ALS courses have been found to improve patient survival outcomes in both adult and neonatal cardiac arrest cases.
| Characteristics | Values |
|---|---|
| Definition | Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend beyond Basic Life Support (BLS) |
| Purpose | To provide urgent treatment to cardiac emergencies |
| Techniques | Advanced airway management, IV access, medication administration, and advanced cardiac life support |
| Skills | Advanced medication administration, injections, and airway procedures |
| CPR | Focuses on the importance of constant, high-quality CPR |
| Defibrillation | Electric shocks (defibrillation) are administered as a single shock, each followed by two minutes of CPR |
| Certification | Requires prior BLS certification and periodic recertification |
| Providers | Highly trained paramedics and other qualified healthcare professionals |
| Conditions Covered | Cardiac arrest, cardiac arrhythmias, poisoning, and conditions that may lead to cardiac arrest |
| Survival Outcomes | Accredited ALS courses have been found to improve patient survival outcomes |
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What You'll Learn
Advanced Cardiac Life Support (ACLS)
ACLS is initiated when cardiac arrest is confirmed, and it involves monitoring the electrical activity of the heart using a cardiac monitor. Healthcare providers must first ensure scene safety and then evaluate the patient's responsiveness and consciousness. If the patient is unconscious, a BLS assessment is performed, which includes checking for breathing and a pulse within 10 seconds. If no pulse is detected, CPR is initiated, which may involve manual chest compressions or the use of automated equipment.
During ACLS, it is crucial to identify and address reversible causes of cardiac arrest, commonly referred to as the "6Hs and 5Ts." These include hypoglycemia, acidosis, hyper/hypokalemia, and metabolic causes. ACLS providers should also monitor blood pressure, oxygen saturation, and cardiac rhythm to determine the need for defibrillation and medication administration.
ACLS training is a vital component of emergency medical education, empowering healthcare professionals with the knowledge and skills to make rapid, evidence-based decisions during critical situations. The structured algorithms provided in ACLS training cover various cardiovascular emergencies, including cardiac arrest, stroke, and acute coronary syndromes.
Upon completion of ACLS course requirements, participants receive a Provider Course Completion Card valid for two years. ACLS training enhances the preparedness and effectiveness of healthcare systems in managing life-threatening cardiovascular events and improving patient survival rates.
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Advanced medication administration
Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend beyond basic life support to further support circulation and provide an open airway and adequate ventilation. Advanced medication administration is a critical component of ALS, and it can be delivered through various parenteral and enteral routes.
Routes of Advanced Medication Administration
- Intravenous (IV): Medications are administered directly into the patient's bloodstream through a vein. This route is commonly used for rapid delivery of drugs and fluids, such as adrenaline (epinephrine), amiodarone, and atropine.
- Intraosseous (IO): This route is used when venous access is not immediately available. Medications are administered into the bone marrow, typically in the tibia or humerus bone, providing a direct route to the systemic circulation.
- Oral (PO): Medications are administered through the mouth and absorbed into the bloodstream via the digestive system.
- Rectal (PR): Medications are given through the rectum, allowing for absorption into the bloodstream via the rectal veins.
- Endotracheal (ET): Medications are delivered directly into the trachea through an endotracheal tube, ensuring direct administration into the respiratory system.
- Sublingual (SL): This route involves placing medications under the tongue, where they are rapidly absorbed into the bloodstream through the rich vascular network in the oral mucosa.
- Topical: Topical medications are applied directly to the skin or affected area, providing localized treatment without entering the bloodstream.
- Transdermal: Transdermal administration involves delivering medications through the skin, allowing them to slowly enter the bloodstream over a more extended period.
Medications Used in Advanced Life Support
The medications administered during ALS depend on the specific condition being treated and the underlying cause. Some common medications used in ALS include:
- Adrenaline (epinephrine): Used to increase perfusion pressure to the heart and brain in cases of cardiac arrest.
- Amiodarone: Administered for shock-refractory ventricular fibrillation, improving survival rates compared to placebo or lidocaine.
- Atropine: Used to manage cardiac arrhythmias and stabilize the heart rhythm.
- Bicarbonate: Helps correct acid-base imbalances in the body.
- Calcium, Potassium, and Magnesium: These electrolytes are administered to address disturbances in mineral levels, such as hypokalemia, and maintain normal cardiac function.
- Antidotes: Specific antidotes may be given to counter the effects of poisoning or drug overdose.
- Rapid Evaluation and Management: ALS providers must quickly assess the patient's condition and administer medications accordingly. This includes recognizing potentially reversible causes of cardiac arrest, such as hypovolemia, hypoglycemia, and acidosis.
- Monitoring and Assessment: Continuous monitoring of the patient's heart rhythm and the effectiveness of interventions is crucial. Cardiac monitors and other advanced equipment are used to guide medication administration and adjust dosages as needed.
- Team Leadership and Delegation: The team leader in an ALS setting must demonstrate exceptional leadership skills and facilitate a clear understanding among team members. In situations requiring advanced procedures, such as advanced airway placement, the team leader may temporarily delegate leadership responsibilities to another qualified team member.
- Simulation-Based Education (SBE): ALS training programs have embraced SBE, utilizing high-fidelity manikins to enhance the experiential learning component. This approach allows practitioners to physically interact with simulated patients, make clinical decisions, and improve their skills in a safe environment.
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Pre-Hospital Trauma Life Support (PHTLS)
PHTLS involves a set of life-saving protocols and skills that extend beyond Basic Life Support (BLS). It emphasises the importance of high-quality and constant CPR, also incorporating more advanced techniques. These include advanced medication administration through various routes such as IV, IO, and ET.
Trained paramedics and emergency medical technicians typically provide PHTLS in out-of-hospital settings. The level of care may vary depending on the region and the qualifications of the emergency responders. For instance, in the United States, paramedic-level services are referred to as Advanced Life Support (ALS), while services staffed by basic EMTs are considered BLS.
PHTLS aims to address the immediate needs of trauma patients, including managing conditions related to cardiac arrest, such as cardiac arrhythmias, and other life-threatening situations. It involves recognising and managing reversible causes of cardiac arrest, such as hypovolemia and hyperkalemia, and employing techniques like defibrillation, chest compressions, and the use of an AED.
Additionally, PHTLS providers must be proficient in reading and interpreting ECGs, understanding pharmacology, and effectively managing pre-arrest, arrest, and post-arrest patients. The goal is to stabilise the patient and provide continuous care until they can be transferred to a hospital for further treatment.
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Pediatric Advanced Life Support (PALS)
PALS courses are available through the American Heart Association (AHA) and the American Red Cross. The AHA offers PALS, PALS Plus, and PEARS (Pediatric Emergency Assessment, Recognition, and Stabilization). The Red Cross PALS course includes online safety coursework and an in-person skills session, allowing learners to proceed at their own pace and place. The course covers the nuances of paediatric care and helps develop clinical decision-making skills.
The PALS curriculum includes basic life support, treatment algorithms, and advanced modules related to pediatric emergencies. It teaches providers to differentiate between patients requiring immediate intervention, recognise cardiopulmonary arrest, and begin CPR within 10 seconds. The course also covers early management of respiratory and cardiac arrest, and peri-arrest conditions such as symptomatic bradycardia.
PALS courses are designed for healthcare providers such as physicians, physician assistants, advanced practice nurses, and emergency medical technicians. These providers may work in emergency response, emergency medicine, intensive care, and critical care units.
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Advanced Trauma Life Support (ATLS)
The goal of ATLS is to teach a simplified and standardized approach to treating trauma patients. The program is designed for emergency situations where only one doctor and one nurse are present. ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centres. It teaches a systematic, concise, safe and reliable approach to the early care of trauma patients.
The premise of ATLS is to treat the greatest threat to life first. It advocates that the lack of a definitive diagnosis and detailed patient history should not delay the application of indicated treatment for life-threatening injuries. The most time-critical interventions are performed early. The first and key part of the assessment of patients presenting with trauma is called the primary survey, during which life-threatening injuries are identified and resuscitation is begun. A simple mnemonic, ABCDE, is used to remember the order in which problems should be addressed. The first step is cervical spine stabilization, followed by airway assessment. If the patient is able to talk, the airway is likely clear.
In military medicine, the ATLS protocol has been modified to the Battlefield Advanced Trauma Life Support (BATLS) protocol, which includes an additional step for catastrophic bleeding (massive external bleeding).
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Frequently asked questions
Advanced Life Support is a set of life-saving skills and protocols that extend beyond Basic Life Support (BLS) and is used to provide urgent treatment to cardiac emergencies.
BLS focuses on giving immediate care at the scene in order to stabilise and support life functions through basic techniques like CPR, rescue breaths, and/or the use of an AED until help arrives. ALS, on the other hand, requires a higher level of care, like advanced airway management, IV access, medication administration, and advanced cardiac life support.
Professionals qualified to provide ALS include highly trained paramedics and other qualified healthcare professionals. Some Primary Care Paramedics are also trained in intravenous cannulation, and are referred to as PCP-IV.
ALS treatment includes high-quality cardiopulmonary resuscitation (CPR) and early defibrillation within the first 3-4 minutes of a sudden cardiac arrest. It also involves the administration of medication and performing injections.
ACLS stands for Advanced Cardiovascular Life Support. ACLS certification is provided to healthcare providers who are expected to keep up with the latest procedures and research while periodically getting recertified. The initial certification consists of a two-day course with written and practical exams, while recertification can be completed in an eight-hour course.
