Welcome to the American Heart Association ACLS EP (Advanced Cardiac Life Support for Healthcare Providers Course.
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This is neither a renewal or initial course. The format for this course is now the same for initial or renewal. All students must take an online exam and watch videos on the AHA website. Upon purchase you will receive a special key to enter the testing and videos on the website.
The cost of this class is $275. Please register and pay for your cours at: http://savingamericanhearts.com/ja1720ahaace.html
This course replaces your ACLS Card and it is well documented on the AHA website that this class is advanced beyond the standard ACLS Course. Written documentation and a link to the AHA website for this information will be provided to you as well. Your ACLS EP Provider card is valid for 2 years.
ACLS EP is the most advanced course offered by the American Heart Association. It was designed to address the critical thinking skills needed by healthcare providers who regularly respond to complex cardiovascular, respiratory and other emergencies, such as physicians and nurses in the emergency and critical care areas and paramedics in prehospital care. This audience should have a mastery of ACLS.
The ACLS EP Course goes beyond ACLS by giving these specialized providers more focus and information to deepen their knowledge around the periarrest, arrest and postcardiac arrest care. In the ACLS EP Course, providers will actively participate in complex case scenarios and apply critical thinking skills to reach a differential diagnosis and rapidly create a treatment plan for the patient.
The goal of the ACLS EP Course is to improve outcomes in complex cardiovascular, respiratory and other (eg, metabolic, toxicologic) emergencies by expanding on core ACLS guidelines and encouraging critical thinking and decision-making strategies. Through instruction and active participation in case-based scenarios, learners enhance their skills in the differential diagnosis and treatment of prearrest, arrest and postarrest patients.
Advanced Cardiac Life Support for Experienced Providers (ACLS EP) is a classroom-based, Instructor-led course, featuring case-based scenarios. In learning stations, interactive case-based discussions are facilitated by the ACLS EP instructor. The cases are designed to promote critical thinking and decision-making.
The ACLS EP Course is for seasoned healthcare providers who are proficient in performing BLS and ACLS skills, reading and interpreting ECGs, and understanding ACLS pharmacology and who regularly lead or participate in emergency assessment and treatment of prearrest, arrest or postarrest patients. This audience includes physicians, paramedics and emergency department or critical care nurses. Also, the Course Director may allow other professionals who are deeply involved in the field of resuscitation, including scientists, educators and researchers, to take the ACLS EP Course.
ACLS EP teaches the following:
• Applying the expanded systematic approach (ACLS EP Survey) to patient assessment, evaluation and management
• Cardiovascular Emergencies
• Cerebrovascular Emergencies
• Respiratory and Metabolic Emergencies
• Post—Cardiac Arrest Care
• Clinical Pharmacology and Toxicology Emergencies
• High Quality CPR
• Effective communication within a resuscitation team and recognition of the impact of team dynamics on overall team performance
The four core learning stations are:
2. Clinical Pharmacology and Toxicology
3. Respiratory and Metabolic
4. Post—Cardiac Arrest Care
For successful course completion, learners must actively participate in all case-based scenarios and must meet all current ACLS course completion requirements including:
• Pass the 1-rescuer CPR and AED skills test
• Pass the bag-mask ventilation skills test
• Pass the Megacode skills test
• Pass the ACLS Provider exam with a score of 84% or higher
There are prerequisites for taking the ACLS EP Course:
There are 2 exams.
1). You must take and pass the traditional ACLS Pre-test. Go to www.heart.org/eccstudent and enter the code aclsep You must get at least 84% to pass. Print this certificate and bring it with you to class.
2). You must get an ACLS EP access key from your instructor to take the second online exam. You have only 2 attempts to pass. If after 2 attempts you have not passed, please contact the course instructor. After completing this online exam you will need to print and bring this certificate with you to class as well. You may also call the instructor and make arrangements to take the written test. This must be done prior to the class.
Before entering an ACLS EP Course, learners are required to have mastered ACLS principles, including proficiency in performing BLS, understanding of the ACLS algorithms, rapid and accurate rhythm recognition and ACLS pharmacology.
All learners must successfully pass both of the ACLS exams before entering an ACLS EP Course.
What to Bring and What to Wear
Bring your American Heart Association (AHA) Advanced Cardiac Life Support EP (ACLS EP) Provider Manual to each class. You will need it during each lesson in the course. You may wish to purchase the AHA’s 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers (optional), which you may bring to the course to use as a reference guide during some of the stations in the course.
Please wear loose, comfortable clothing to class. You will be practicing skills that require you to work on your hands and knees, and the course requires bending, standing, and lifting. If you have any physical condition that might prevent you from engaging in these activities, please tell an instructor. The instructor may be able to adjust the equipment if you have back, knee, or hip problems.
The course is taught in a STRESS FREE, FUN environment. I want you to leave class feeling like you're glad you came, you learned a lot and you ACTUALLY HAD FUN !!!
You will MASTER all the skills you need to run a code and learn all the rhythms and drugs to treat them. IT'S A PIECE OF CAKE !!! STRESS FREE ! FUN !!
Continuing Education Accreditation—Emergency Medical Services:
This continuing education activity is approved by the American Heart Association, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 7.25 Advanced CEHs, activity number 13-AMHA-F2-0175.
If you have any questions about the course, please email Catherine Brinkley at firstname.lastname@example.org or call/text (719) 551-1222.
(Study Guide for the ACLS EP is in progress and will be posted here when complete)
SAVING AMERICAN HEARTS ADVANCED CARDIAC LIFE SUPPORT STUDY GUIDE Based on the 2010 Guidelines of the American Heart Association Traditional Advanced Cardiac Life Support
Always begin with chest compressions, not breaths. Give 30 compressions and 2 breaths.
5 cycles of 30 compressions and 2 breaths = 2 minutes. Check for a pulse every 2 minutes, and switch providers every 2 minutes so that the person giving compressions does not get too tired.
Good quality compressions must be given. For adults, compress at least 2 inches or 5 cm. Always let the chest completely recoil.
Provide at least 100 compressions per minute.
Do not spend more than 5 - 10 seconds assessing the patient, or checking for a pulse.
If you are unsure if they have a pulse, begin chest compressions.
Keep interruptions in chest compressions to 10 seconds or less.
Waveform capnography is written as PETCO2 (Patient End Tidal CO2) The normal is 35-40.
If your PETCO2 number is less than 10, this indicates ineffective chest compressions.
Waveform capnography is used to measure CPR quality and determine ROSC (Return of Spontaneous Circulation).
Waveform capnography is the MOST reliable indicator of ETT placement. If the person doing the intubation happens to get the ETT into the esophagus vs the trachea, there would be no waveform capnography reading.
When providing breaths, if doing compressions give 30 compressions and 2 breaths. Each breath should be given over 1 second, and only until you see the chest rise. Giving a bigger breath will only fill the stomach with air which will compress the diaphragm, chest and lungs making it difficult to resuscitate your patient.
If your patient has a pulse and simply cannot breath, provide breaths at a rate of 1 breath every 5-6 seconds = 10-12 breaths/min.
If your patient is intubated (has an advanced airway ), provide 1 breath every 6-8 seconds = 8-10/min. When an advanced airway is in place, compressions should not be paused to give breaths.
GUIDELINES FOR SYNCHRONIZED CARDIOVERSION
UNSTABLE ATRIAL FIBRILATION
The initial BIPHASIC energy dose should be between 120-200 Joules
UNSTABLE SVT OR UNSTABLE ATRIAL FLUTTER The initial BIPHASIC energy dose should be between 50-100 Joules
RHYTHMS WITH MONOPHASIC WAVEFORMS
The initial MONOPHASIC or BIPHASIC energy dose should begin with 200 Joules and increase in a stepwise fashion if not successful
UNSTABLE MONOMORPHIC VT
The initial MONOPHASIC or BIPHASIC energy dose of 100 Joules If the initial shock fails, always increase the dose in a stepwise fashion.
Used only when your patient remains unresponsive following cardiac arrest, especially those who presented with an initial rhythm of v-fib. These patients are cooled to 32-34 degrees celsius for 12-24 hours. If your patient wakes up and follow commands, do not start hypothermia protocol.
Any patient having chest pain should have an EKG first. You must know if they are having a STEMI.
(ST segment elevation) must go to the cath lab for an angiogram or they will die. The heart muscle is not perfusing.
(ST depression) usually are able to go home on blood thinners.
The only exception to the EKG first, is a patient where the chest pain is caused by their heart rate. If they are unstable, synchronized cardio version should be the first treatment.
So, if an ambulance is bringing you a STEMI patient, and your facility does not have the capabilities to do a heart cath, or angiogram, these patients need to be diverted to a specialty cardiac hospital even if it’s an hour away. If you accept the patient, you then have to get admit orders, have consents signed, do the whole med rec and then get transfer orders, find an accepting doctor and transfer the patient anyway. The patient would be better off getting closer to the special hospital.
The same goes for the stroke patients, if your hospital’s CT scan is broken, you need to divert them as well. Anyone with stroke symptoms should have their blood sugar checked FIRST.
Numerous people come to ER with decreased LOC, slumping to one side and slurred speech because they took their insulin this morning and haven’t eaten all day. Checking blood sugar is a really fast way to rule out a stroke.
The SECOND thing you want to do is called a Cincinnati Pre-Hospital Stroke Assessment Scale.
It’s a very quick assessment Check for FACIAL DROOP, SLURRED SPEECH, and ARM DRIFT.
The THIRD thing you need to do is get that CT SCAN. You need to know if they are having an ischemic stroke or a hemorrhagic stroke. If they are bleeding, they will not get the fibrinolytics.
Atropine is no longer used in the AYSTOLE/PEA Algorithm The American Heart Association defines PEA as sinus rhythm without a pulse.
Atropine is the first line treatment for any bradycardia regardless of the type, a dopamine drip should be started at 2-10 mcg/kg/min if the rhythm is a 3rd degree block. Run the dopamine until pacing begins.
The preferred method of epinephrine administration is via peripheral. During a code there is no time to obtain central venous access.
When attempting IV access, peripheral access should be tried first, if that is unsuccessful move to I/O access. The recommended fluid bolus for a patient who achieves ROSC and is hypotensive is 1-2 Liters. You want to get a minimal SBP of at least 90 to ensure perfusion. Once your patient achieves ROSC you need to make sure they are oxygenated and ventilated. This is now your first priority.
Providing quality chest compressions immediately before a defibrillation attempt will improve successful conversion of V-Fib.
The American Heart Association says that it is acceptable to stop resuscitation efforts if the patient has not had a pulse for 15 consecutive minutes. Except in special cases of drowning or hypothermia.
Always be aware of safety hazards. Don’t ever cut adult pads in half or shock a patient if there is oxygen blowing across their chest. The oxygen combined with the electric spark could cause a small explosion or ball of fire that injures everyone in the room.
When possible, use the hands free pads. Paddles take much longer to deliver a shock because you must add the conduction jelly and after the shock is delivered, someone is stuck holding them.
Always provide chest compressions while the defibrillator is charging. The time it takes to analyze is several seconds, you want to make the hands-off period of time as short as possible. Some defibrillators can take up to 45 seconds to charge.
Remember when suctioning a patient, do not suction for longer than 10 seconds.
Always make sure you have a 6 second rhythm strip if you are going to be counting the QRSs by 10 to get your heart rate. If you have a 12 second strip and do this you are likely to end up with a heart rate of 80 when it’s actually only 40. The treatment is significantly different.
Always make sure the scene is safe before providing any help to someone. It would not do anyone any good if you ran out into the middle of the street to save someone and get hit by a car. Make sure You assess the scene for safety hazards first.
The initial priority for ANY tachycardia is do they have a pulse or not. The treatment for each is completely different.
The only rhythm you will ever shock is V-Fib and pulseless V-Tach.
The only rhythm you will ever cardiovert is an unstable tachycardia whether it’s SVT or atrial does not matter. When placing ties circumferentially around a patient’s neck to secure the airway, be sure you don’t make it so tight that you cut off venous return to the brain.
Vasopressin can only be used in place of the first or second dose of epinephrine.
Cricoid pressure is no longer recommended. It used to be done routinely, when providers were attempting to occlude the esophagus and prevent vomiting, however inexperienced providers were also unknowingly occluding their airway too. So It is not longer recommended.
http://www.savingamericanhearts.com Catherine Brinkley (719) 551-1222. email@example.com