Every hospital in the world has some sort of ACLS team. These teams may vary by make up and/or term, but they all have the same function. To do everything possible in the event of sudden cardiac arrest or respiratory arrest. An arrest, in medical terminology, refers to the sudden stopping or cessation of any body function. In the case of a cardiac arrest, for example, refers to the sudden cessation of heart functions such as beating. This is known as ASYSTOLE, or absence of a heart rhythm, it is also known by a more generic term called a flat line. But lets take a look at what ACLS is, and what is involved. This will also include a very basic description of physiology and biochemistry for some topics and sub topics.
ACLS is the acronym for the term Advanced Cardiac Life Support. This term refers to the response of physicians, nurses, and respiratory therapists to a situation in which a person has developed or is experiencing a sudden cardiac or respiratory arrest. As earlier stated every hospital world wide has some form of this team. The roles are specific to a persons license and competency levels. for example; the physician will be the person responsible for the running of the code ( aka code blue ), it is the physicians responsibility to monitor the patients/victims heart rhythm, order the medications to be given, place any advanced airway that may be needed ( respiratory therapists can also place these devices ), the physician will also be the one to deliver the shock ( defibrillation ). The nurses roles are to administer the medications via I.V., central line ( intra jugular, picc ), or a femoral line. they are also the ones that perform the chest compressions and often times the respiration via non rebreather mask or ambu bag. Respiratory therapists typically are the once to " bag " the victim, administer respiratory drugs, and back up as the ones doing chest compressions. Lets look at some specific items used in ACLS.
DEFIBRILLATOR- This is a device designed for and used by hospitals, ambulances, medical aircraft, cruise ships, and just about any other place where there may be a large group of people. It is used to monitor a persons heart rhythm, and if needed deliver an electrical shock through the chest to the heart in an effort to restart the hearts own electrical systems. It is also used in rare cases to pace a person experiencing symptomatic bradycardia ( slow heart rate ). Many of the new models have algorithms programmed in, that assist the physicians, nurses, and paramedics in determining if a shock should be delivered. There are three main types of defibrillators. An AICD, this is a device that is built into many pace makers that detect potentially lethal rhythms and delivers a shock directly into the heart itself. Next, is the AED, Automated External Defibrillator. These are found almost everywhere, in police cars, hotels, restaurants, airplanes, and many more. It is simple to use and anybody can be trained to use it. Next is the combination monitor/defibrillator. These are used most often by hospitals and ambulances. It is to be used only by trained and certified personnel, such as nurses, doctors, and paramedics.
AIRWAYS- Any advanced airway should only be placed by a physician, respiratory therapist, paramedic, or nurse. these are specially designed tubes that are inserted through a persons mouth, down the trachea ( wind pipe ), to a place where the trachea bifurcates ( splits ) into the two separate lobes of the lungs. Once this is in place, a small balloon is inflated with air to first secure it, and second to prevent the patient from aspirating ( breathing into the lungs ) and saliva or emesis ( vomit ). The most common is called the ET ( endo-tracheal ) tube. There are several others, but in the interest of space we will not cover these.
MEDICATIONS- there are a handful of medications that are used to try and start a persons heart and lungs working again. Epinephrine, this drug is used to stimulate the heart to beat stronger and faster, Atropine, this drug is used to force the heart to beat faster and stronger as well, but is used for people with a very slow heart rate. Amiodorone, this is a drug that is known as an anti-arrhythmic, it forces the heart to beat in a more regular manner. Vaso-pressors, these drugs are given to force a persons blood pressure to rise. There are more, but not practical to discuss here.
Lets look at some various terms and acronyms you may hear during a code
- Code Blue-A term used to indicate a need to activate the Cardiac response team. It signifies that a person is in significant trouble such as cardiac or respiratory arrest.
- Code-See code blue
- Amio- abbreviation for the drug amiodorone
- EPI-abbreviation for the drug epinephrine
- Shock- To deliver an electrical shock to the heart in an attempt to restart the conduction system of the heart
- Compressions- Chest compressions during CPR
- CPR- Cardio Pulmonary Resuscitation
- ET- Endo tracheal tube airway
- SVT- Sinus Ventricular Tachycardia
- Asystole- Absence of a heart rhythm
- V-tach- Ventricular tachycardia
- V-Fib- Ventricular Fibrillation
- Adenosine- A drug used to slow a heart rate
- Atropine- A drug used to speed a heart rate
- Cart- A cart that holds the items required to restart a persons heart and breathing.
- TOD- Time of Death
Often during a code, the physician will order a persons cbg, Concentrated Blood Glucose, to be checked. Often a diabetic will have a drop in blood sugars that caused the crisis. During any code a full range of blood tests will be performed to determine the possible cause or reason for the crisis. This is often called a rainbow draw. These tests will include a CBC ( complete blood count ), CMP ( comprehensive metabolic panel ), BMP ( basic metabolic panel ), CHEM ( chemistry panel ), Troponin ( a cardiac marker enzyme ), Glucose ( blood sugar ), PTT ( pro thrombin time ), and a PT/INR ( protime with an international ratio ). these are all performed STAT ( needed by last week ).
During a heart attack there are several factors occurring. Often the is a significant change in a persons electrolytes causing heart rhythm changes and if significant enough cause the heart to stop beating. Most often however a heart attack is caused by a blockage in one of the vessels in the heart. This blockage causes that local area to infarct ( die ). so when you hear the term MI, it means Myocardial Infarction, death to a portion of the heart muscle. Another common drug given in a code in Magnesium. this has an irritating effect on the myocardium, leading to stronger contractions of the heart muscle. sodium and Potassium are also major players in a heart condition.
So what happens after the code? After the code, and the patient survives, the person is placed on a ventilator to assist the breathing and let those related muscles relax and recover somewhat. Another medication called Propofol is given to sedate the patient. In all cases the patient should be moved to the ICU ( intensive care unit ) since they are generally the only area in which propofol can be given, since this drug required significant amount of monitoring and because of the need to ventilate the patient. Once the patient can be taken off the ventilator, a procedure called a cardiac catheterization is performed to clear the blockage and hopefully restore proper blood flow. A significant care plan is determined and the patient and the rest of the team work to bring the patient to the best possible level of functioning.