Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend

basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any ...

to further support the circulation and provide an open airway and adequate ventilation (breathing).

Components

Key aspects of ALS level care include: *

Tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer c ...

* Rapid sequence induction * Cardiac rhythm monitoring by ECG *

Cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of ...

and

defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...

using a manual or automated external defibrillator *

Transcutaneous pacing Transcutaneous pacing (TCP), also called external pacing, is a temporary means of pacing a patient's heart during a medical emergency. It should not be confused with defibrillation (used in more serious cases, in ventricular fibrillation and other ...

Ultrasonography Medical ultrasound includes diagnostic techniques (mainly imaging) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles, joints, ...

* Intravenous cannulation (IV) * Intraosseous (IO) access and intraosseous infusion * Surgical cricothyrotomy * Needle cricothyrotomy * Needle or finger thoracostomy of

tension pneumothorax A pneumothorax is collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is formed b ...

* Pericardiocentesis * Advanced

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

administration through

parenteral In pharmacology and toxicology, a route of administration is the way by which a drug, fluid, poison, or other substance is taken into the body. Routes of administration are generally classified by the location at which the substance is applied. ...

and enteral routes (IV, IO, PO, PR, ET, SL, topical, and transdermal) * Advanced cardiac life support (ACLS) * Pediatric Advanced Life Support (PALS) or Pediatric Education for Pre-Hospital Providers (PEPP) * Pre-Hospital Trauma Life Support (PHTLS), Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS)

Algorithms

In cases of

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

, ALS builds on the foundations of

(BLS) interventions such as bag-mask ventilation with high-flow

oxygen Oxygen is a chemical element; it has chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen group (periodic table), group in the periodic table, a highly reactivity (chemistry), reactive nonmetal (chemistry), non ...

, chest compressions, and use of an AED. The core

algorithm In mathematics and computer science, an algorithm () is a finite sequence of Rigour#Mathematics, mathematically rigorous instructions, typically used to solve a class of specific Computational problem, problems or to perform a computation. Algo ...

of ALS that is invoked when cardiac arrest has been confirmed, Advanced Cardiac Life Support (ACLS), relies on the monitoring of the electrical activity of the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

on a cardiac monitor. Depending on the type of

cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beat ...

and/or

may be administered.

Oxygen Oxygen is a chemical element; it has chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen group (periodic table), group in the periodic table, a highly reactivity (chemistry), reactive nonmetal (chemistry), non ...

is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effectiveness of the interventions on the heart rhythm, as well as the presence of

cardiac output In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: tha ...

, is assessed. Medications that may be administered include

adrenaline Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...

(

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands a ...

amiodarone Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, atrial fibrillation, and paroxys ...

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically give ...

bicarbonate In inorganic chemistry, bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. It is a polyatomic anion with the chemical formula . Bicarbonate serves a crucial bioche ...

calcium Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to it ...

potassium Potassium is a chemical element; it has Symbol (chemistry), symbol K (from Neo-Latin ) and atomic number19. It is a silvery white metal that is soft enough to easily cut with a knife. Potassium metal reacts rapidly with atmospheric oxygen to ...

and

magnesium Magnesium is a chemical element; it has Symbol (chemistry), symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 ...

, among others. Saline or colloids may be administered to increase the circulating volume. While CPR is performed (which may involve either manual chest compressions or the use of automated equipment such as the AutoPulse or LUCAS device), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as “6Hs & 5Ts” according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS).''ACLS: Principles and Practice''. p. 71–87. Dallas: American Heart Association, 2003. .''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ."2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." ''Circulation'' 2005; 112: IV-58 – IV-66. Note these reversible causes are usually taught and remembered as 4Hs and 4TsResuscitation Council UK adult ALS algorithm 2005
—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation.

Hs and Ts

;'H's * Hypoxia: low oxygen levels in the body's tissues *

Hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...

: low amount of circulating blood, either absolutely due to blood loss or relatively due to

vasodilation Vasodilation, also known as vasorelaxation, is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. Blood vessel wa ...

Hyperkalemia Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Oc ...

hypokalemia Hypokalemia is a low level of potassium (K+) in the blood serum. Mild low potassium does not typically cause symptoms. Symptoms may include feeling tired, leg cramps, weakness, and constipation. Low potassium also increases the risk of an a ...

: disturbances in the level of

in the blood, and related disturbances of

levels. *

Hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe ...

Hyperthermia Hyperthermia, also known as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme te ...

: body temperature not maintained *

Hydrogen Hydrogen is a chemical element; it has chemical symbol, symbol H and atomic number 1. It is the lightest and abundance of the chemical elements, most abundant chemical element in the universe, constituting about 75% of all baryon, normal matter ...

ions (

Acidosis Acidosis is a biological process producing hydrogen ions and increasing their concentration in blood or body fluids. pH is the negative log of hydrogen ion concentration and so it is decreased by a process of acidosis. Acidemia The term ac ...

) ;'T's *

Tension pneumothorax A pneumothorax is collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is formed b ...

: increased pressure in the thoracic cavity, leading to decreased venous return to the heart * Tamponade: fluid or blood in the

pericardium The pericardium (: pericardia), also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong inelastic connective tissue (fibrous pericardium), ...

, compressing the

Toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subst ...

and/or therapeutic: chemicals, whether medication or poisoning * Thromboembolism and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a

blood clot A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulatio ...

or other material) As of December 2005, advanced cardiac life support guidelines have changed significantly. A major new worldwide consensus has been sought based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30:2 for adults, to produce higher coronary and cerebral perfusion pressures.

Defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...

is now administered as a single shock, each followed immediately by two minutes of CPR before rhythm is re-assessed (five cycles of CPR).

Other conditions

ALS also covers various conditions related to cardiac arrest, such as

s (

atrial fibrillation Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods ...

ventricular tachycardia Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple ...

poison A poison is any chemical substance that is harmful or lethal to living organisms. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figurati ...

ing and effectively all conditions that may lead to cardiac arrest if untreated, apart from the truly surgical emergencies (which are covered by

Advanced Trauma Life Support Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute Trauma (medicine), trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as ...

ALS providers

Many emergency healthcare providers are trained to administer some form of ALS. In out-of-hospital settings, trained paramedics and some specifically trained emergency medical technicians typically provide this level of care. Canadian paramedics may be certified in either ALS (Advanced Care Paramedic-ACP) or in basic life support (Primary Care Paramedic-PCP). Some Primary Care Paramedics are also trained in intravenous cannulation, and are referred to as PCP-IV (see paramedics in Canada).

Emergency medical technician An emergency medical technician (often, more simply, EMT) is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and som ...

s (EMTs) are often skilled in ALS, although they may employ a slightly modified version of the medical algorithm. In the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

, Paramedic level services are referred to as advanced life Support (ALS). Services staffed by basic EMTs are referred to as basic life support (BLS). Services staffed by advanced emergency medical technicians can be called limited advanced life support (LALS), Intermediate Life Support (ILS), or simply advanced life support (ALS), depending on the State. In

Ireland Ireland (, ; ; Ulster Scots dialect, Ulster-Scots: ) is an island in the North Atlantic Ocean, in Northwestern Europe. Geopolitically, the island is divided between the Republic of Ireland (officially Names of the Irish state, named Irelan ...

, advanced life support (ALS) is provided by an advanced paramedic. Advanced Paramedic (AP) is the highest clinical level (level 6) in pre-hospital care in

based on the standards set down by PHECC, the Irish regulatory body for pre-hospital care and ambulance services. In the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...

paramedics are registered healthcare professionals with the

Health and Care Professions Council The Health and Care Professions Council (HCPC), formerly the Health Professions Council (HPC), is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpos ...

and are qualified to ALS level. This terminology extends beyond emergency cardiac care to describe all the capabilities of the providers. In hospitals, ALS is usually given by a team of doctors and nurses, with some clinical paramedics practicing in certain systems. Cardiac arrest teams, or “Code Teams” in the US, generally include doctors and senior nurses from various specialties such as

emergency medicine Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...

, anesthetics,

general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...

internal medicine Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of ...

References

External links

Adult advanced life support
on UK Resuscitation Council website
ACLS & BLS Training Programs by AHA-Certified Shifa LiST Center
{{DEFAULTSORT:Advanced Life Support Emergency medicine Medical credentials pl:Reanimacja