AHA Advanced Cardiovascular Life Support (ACLS) – Full Course

Course Description:

Overview:

The AHA’s ACLS course builds on the foundation of lifesaving BLS skills, emphasizing the importance of continuous, high-quality CPR. Reflects science and education from the American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care (ECC).

Course Objectives

1. Basic life support skills, including effective chest compressions, use of a bag-mask device, and use of an AED
2. Recognition and early management of respiratory and cardiac arrest
3. Recognition and early management of peri-arrest conditions such as symptomatic bradycardia
4. Airway management
5. Related pharmacology
6. Management of ACS and stroke
7. Effective communication as a member and leader of a resuscitation team

Target Student:

The goal of this program is to provide students a valuable and enjoyable hands-on training experience. 

The fundamental objective is to use a simple, practical approach to help students develop necessary knowledge, skills, and confidence to provide and direct lifesaving interventions as a lead emergency medical responder. 

Course Content:

Lesson 1: The ABCDs of Emergency Cardiac Care

1. Identify the risk factors for coronary artery disease.
2. Define “cardiac arrest” and “sudden cardiac death.”
3. Identify and describe the links in the Chain of Survival.
4. Name four heart rhythms associated with cardiac arrest.
5. Differentiate “shockable” cardiac arrest rhythms from “nonshockable” cardiac arrest rhythms.
6. Identify the components of advanced cardiac life support.
7. Describe the phases of cardiopulmonary resuscitation.
8. List the purpose of components of the primary and secondary surveys.
9. Explain advanced directives and do not resuscitate (DNR) orders.

Lesson 2: Airway Management Oxygenation and Ventilation

1. Name the major structures of the respiratory system.
2. Describe the oxygen liter flow per minute and estimated oxygen percentage delivered for each of the following devices:
   • Nasal cannnula
   • Simple face mask
   • Partial nonrebreather mask
   • Nonrebreather mask
   • Venturi Mask
3. Describe the steps in performing the head-tilt / chin-lift and jaw thrust without head-tilt maneuvers for opening the airway.
4. Relate mechanism of injury to opening the airway.
5. Describe correct suctioning technique and complications associated with the procedure.
6. Describe how to correctly size and insert and oral airway and a nasal airway.
7. Describe the indications for positive-pressure ventilation.
8. Describe the oxygen liter flow per minute and estimated inspired oxygen concentration delivered for a pocket mask and bag-mask device.
9. Describe how to ventilate a patient with a bag-mask using one and two rescuers.
10. Describe the signs of adequate and inadequate bag-mask ventilation.
11. Describe the advantages and disadvantages associated with the use of an automatic transport ventilator (ATV) and a flow-restricted, oxygen-powered ventilation device.
12. Describe the indications, advantages, and technique for advanced airways including Combitube, laryngeal mask airway (LMA), and endotracheal (ET) tube.

Lesson 3: Rhythm Recognition

1. Name the primary branches of the right and left coronary arteries.
2. Describe the two types of myocardial cells and the function of each.
3. Describe the significance of each waveform in the cardiac cycle.
4. Describe the normal duration of the PR interval and QRS complex.
5. Describe at least two methods of determining heart rate.
6. Name the primary and escape pacemakers of the heart and the normal rates of each.
7. Define the absolute and relative refractory periods and their location in the cardiac cycle.
8. Describe the electrocardiogram (ECG) characteristics of narrow-QRS tachycardias.
9. Describe the ECG characteristics and wide-QRS tachycardias.
10. Describe the differentiation of right and left bundle branch block (BBB) using lead V1 or modified chest lead (MCL1)
11. Describe the ECG characteristics of irregular tachycardias.
12. Describe the ECG characteristics of sinus bradycardia, junctional escape rhythm, and ventricular escape rhythm.
13. Describe the ECG characteristics of first-, second-, and third-degree atrioventricular (AV) blocks.
14. Name and describe four dysrhythmias that may be observed during cardiac arrest.
15. Describe the appearance of the waveform on the ECG produced as a result of atrial pacing and ventricular pacing.

Lesson 4: Electrical Therapy

1. Explain defibrillation and name three indications for this procedure.
2. Describe four factors affecting transthoracic resistance.
3. Describe proper placement of hand-held defibrillator paddles or self-adhesive monitoring / defibrillation pads.
4. Discuss monophasic and biphasic defibririllation.
5. Describe the procedure for defibrillation.
6. Explain synchronized cardio-version and name three indications for this procedure.
7. Describe the differences in the delivery of energy relative to the cardiac cycle with synchronized cardio-version and defibrillation.
8. Describe the procedure for synchronized cardio-version.
9. For each of the following rhythms, identify the energy levels currently recommended and indicate if the shock delivered should be a synchronized or unsynchronized counter shock:
   • Pulseless ventricular tachycardia (VT) / ventricular fibrillation (VF).
   • Monomorphic VT
   • Polymorphic VT
   • Narrow-QRS tachycardia
   • Atrial fibrillation with a rapid ventricular response
   • Atrial flutter with a rapid ventricular response.
10. Differentiate between a fully automated external defibrillator (AED) and a semi-automated external defibrillator.
11. List the steps in the operation of an automated external defibrillator.
12. Explain the precautions that should be taken when defibrillating a patient with a permanent pacemaker or an implantable cardioverter-defibrillator.
13. Discuss indications for transcutaneous pacing.
14. List possible complications of transcutaneous pacing.

Lesson 5: Vascular Access and Medications

1. Describe the indications for intravenous (IV) therapy.
2. Describe the sites of first choice for cannulation if no IV is in place at the time of cardiac arrest.
3. Describe the advantages of peripheral venipuncture over central venous access.
4. Describe the indications for central venous access.
5. List four local complications common to all IV techniques.
6. List four systemic complications common to all IV techniques.
7. Describe the use of the intraosseous (IO) and endotracheal routes as alternate routes of medication delivery in cardiac arrest.
8. Describe the location and effects of stimulation of alpha, beta, and dopaminergic receptors.
9. Define the following terms: afterload, agonist, antagonist, chronotrope, dromotrope, inotrope, parasympatholytic, preload, and sympathomimetic.
10. Identify the mechanism of action, indications, dosage, and precautions for each of the following medications:

Lesson 6: Acute Coronary Syndromes

1. Define acute coronary syndromes (ACS).
2. Describe the pathophysiology of coronary artery disease and the process of atherosclerosis.
3. Differentiate the characteristics of stable (classic) angina, unstable angina, and acute myocardial infarction (MI).
4. Explain atypical presentation and its significance in ACS.
5. Identify the electrocardiogram (ECG) changes associated with myocardial ischemia, injury, and infarction.
6. Explain the ECG criteria for significant ST-segment changes.
7. Describe the initial assessment and immediate general treatment of acute coronary syndromes.
8. Describe the inital management of a patient experiencing ST-elevation MI (STEMI), non-ST elevation MI (NSTEMI), and unstable angina.
9. Explain the importance of the 12-lead ECG in ACS.
10. Identify the ECG leads that view the anterior wall, inferior wall, lateral wall, and septum.
11. Explain the clinical and ECG features of right ventricular infarction (RVI).
12. Identify the most common complications of an acute MI.

Lesson 7: Stroke and Special Resuscitation Situations

1. Describe the two major types of stroke.
2. Describe the sequence of events that occurs during a stroke.
3. Discuss why stroke must be treated within the early hours of symptom onset.
4. Identify the signs and symptoms of stroke.
5. Understand the significance of a transient ischemic attack (TIA).
6. Describe the initial emergency care for each of the following situations:
   • Stroke
   • Drowning
   • Near-fatal asthma
   • Anaphylaxis
   • Hypothermia
   • Traumatic cardiac arrest
   • Cardiac arrest and pregnancy
   • Electric shock and lightning strike

Lesson 8: Putting It All Together

1. Describe the role of each member of the resuscitation team.
2. Discuss the “phase response” of code organization.
3. Describe the critical actions necessary in caring for the adult patient in cardiac arrest.
4. Identify the immediate goals of post-resuscitation care.
5. Given a patient situation, describe the initial emergency care (including mechanical, pharmacological, and electrical therapy where applicable) for each of the following situations.
   • Cardiac arrest rhythms – Pulseless ventricular tachycardia (VT) / ventricular fibrillation (VF), asystole, pulseless electrical activity (PEA).
   • Too slow rhythms – Symptomatic bradycardia
   • Too fast rhythms – Narrow-QRS tachycardia, wide-QRS tachycardia, irregular tachycardia
   • Acute coronary syndromes – ST-elevation myocardial infarction (STEMI), unstable angina / non-ST-elevation myocardial infarction (NSTEMI), nondiagnostic / normal electrocardiogram (ECG)