Analysis of the AHA Year 2000 ACLS Guidelines

Universal Initial and Second-level "ABCD"

Initial ABCD

• Basic CPR

• Rate of compressions-at least 100 per minute;

• Ratio 15 compressions: 2 ventilations with unsecured airway;

• Continuous compressions if patient is intubated successfully and is pulseless; ventilations should be 12-15 per minute, asynchronously;

• Defibrillation- initially x 3 (Zoll M Series biphasic--120J,150J-200J; conventional 200J, 200-300J, 360J)

Second-level ABCD

Initial priority here is securing airway (ETT or ETCombitube), ventilating with 100% O2; then securing IV access and providing appropriate drugs and differential diagnosis

A: Airway: ET intubation

• Confirming placement with a minimum of

  • EDD and 6-step auscultation sequence (1.over epigatrium, 2-3 bilateral midaxillary,  4-5. bilateral midclavicular, 6. Over epigastrium again) or

  • 6-step auscultation sequence and use of end tidal CO2 detector, or

  • combination of 1 and 2

• Secure ETT with commercial device after correct placement confirmed;

• Apply cervical collar to restrict unnecessary head movement

B. Breathing

• Ventilation -optimize delivery of supplemental O2—100%

C. Circulation

• Access -14 or 16 ga IV

  • Antecubital fossa, if unsuccessful,

  • External jugular vein

• Using 0.9% NaCl IV solution, macrodrip infusion set-up

D. Drug administration

• 20-30 ml fluid bolus to follow drug administration and elevate extremity if using antecubital site;

D. Differentials in Diagnosis

• Exploring such causes as "5 H's and 5 T's"

  • Hypovolemia

  • Hypoxia

  • Hydrogen ion - acidosis

  • Hyper - /hypokalemia

  • Hypothermia

  • "Tablets" (drug OD, accidents)

  • Tamponade, cardiac

  • Tension pneumothorax

  • Thrombosis, coronary (ACS)

  • Thrombosis, pulmonary (embolism)

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