Today our topic of discussion is Advanced Cardiac Life Support.
Advanced Cardiac Life Support
ADVANCED CARDIAC LIFE SUPPORT
The provision of basic life support-airway maintenance, ventilatory assistance, and external chest compression is the first step toward facilitating survival for the victim of cardiopulmonary arrest (Figs. 30.1 and 30.2).
Airway and Ventilatory Support
- Oxygenation: Essential aspect of resuscitation is to achieve optimal ventilation and oxygenation. Although artificial ventilation provides a normal partial pressure of oxygen, there is arterial hypoxemia because of diminished cardiac output, intrapulmonary shunting and ventilation perfusion mismatch which can be corrected with supplementary oxygen.
- Airway adjuncts: There is a possibility of continued soft tissue obstruction which can be relieved by oropharyngeal and nasopharyngeal airway. Oral airway must be of proper size and positioned so that the patients tongue is completely encircled by the airway.
- Masks: A well-fitting mask can be used to supply higher concentration of oxygen through an oxygen insufflation inlet.
- Ventilation circuits: If the patient’s spontaneous ventilation is inadequate assistance is provided using manual ventilating unit. There are two types of manual resuscitators which are self-refilling and nonself-refilling units.
- The self-refilling units are referred as bag mark devices or Ambu bags. The nonself-refilling Magill circuit with 1 piece circuit.
- Endotracheal intubation: In most of the cardiopulmonary arrests ventilation can be achieved by simple airway restoration.
- Endotracheal intubation should be attempted by experienced person when all the equipment are ready.
- After placing the endotracheal tube in place good airway control is possible, with better regulation of FiO,, airway pressure and ventilatory pattern is offered.
- Ventilation and tube function is to be monitored closely as there is danger of blocked or malfunctioning endotracheal tube.
- Support of circulation: Chest compressions during advanced cardiac life support (Fig. 30.3) are performed in the same manner as Basic Life Support (Fig. 30.4).
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