Advanced cardiac life support (ACLS): Clinical

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Advanced cardiac life support (ACLS): Clinical

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A 61-year-old man comes to the emergency department with two weeks of fevers and chills. He also reports a poor appetite and has noticed a weight loss of 2.3 kg (5 lb) over the past month. He also complains of malaise with intermittent headaches, muscle aches, and night sweats over this same time period. Medical history is significant for chronic kidney disease (CKD) stage II, due to hypertension. Medications include lisinopril and hydrochlorothiazide. He was born in India, and he does not drink alcohol or use recreational drugs. His temperature is 39.4°C (102.9°F), pulse is 45/min, respirations are 23/min, blood pressure is 100/50 mmHg, and oxygen saturation is 95% on room air. He appears ill. Physical exam shows a regularly irregular heartbeat with a high-pitched, early diastolic decrescendo murmur. Lung auscultation reveals crackles at the bilateral lung bases. Laboratory studies show renal function at baseline and normal cardiac enzymes. An ECG is obtained and shows the following:  

 Reproduced from: Wikimedia Commons

Which of the following is the most appropriate management of this patient?  


Advanced cardiac life support, or ACLS, is a structured way to respond to an unresponsive person with cardiac arrhythmias and cardiac arrest.

ACLS can be done by an individual or by a team that’s led by a team leader.

When we suspect a person may be in need of assistance, the first thing we need to do is determine their level of consciousness.

Talk loudly at them, rub their sternum, or apply pressure to their nail beds or ear lobes, while simultaneously checking for absent or abnormal breathing.

If they're not responsive, check their carotid pulse for about 10 seconds. If there's no pulse, first immediately activate the emergency response system to get more help and an AED or defibrillator. Then, move on to the ACLS algorithm.

The first thing to do is cardiopulmonary resuscitation or CPR, which combines chest compressions and artificial ventilation.

The big picture goal of CPR is to maintain blood flow to the brain while a patient is pulseless. Because the patient’s heart is not functioning, the team is mechanically squeezing the heart to ensure blood flows to the brain.

In a person over 8 years of age, chest compressions are done by placing the heel of one hand in the center of the chest, then placing the other hand on top, interlocking the fingers, and without flexing the elbows, pushing down on the chest to a depth of at least 5 centimeters or 2 inches - which is about the same size as a closed fist lengthwise.

Compressions are done at a rate of about 100 compressions per minute, which you can remember if you do them to the beat of “Staying alive” by the Bee Gees.

Additionally, the team attempts to artificially ventilate the patient so oxygen can enter the lungs and carbon dioxide can leave the lungs.

Artificial ventilation includes a variety of ways to assist respiration for a person who isn’t breathing or making sufficient respiratory effort on their own.

The options for ventilation usually involve a bag valve mask device to push air in.

A bag valve mask can be applied directly to the person’s mouth, or with an oral airway, a supraglottic airway like a laryngeal mask airway or LMA, or an endotracheal tube.


ACLS is a set of clinical interventions that are designed to save the lives of people who are experiencing cardiac arrest. The main aim of ACLS is to improve the chance of survival by restoring a normal heart rhythm as quickly as possible.

The key components of ACLS include: 1) providing CPR (cardiopulmonary resuscitation) 2) using an automated external defibrillator (AED) 3) giving oxygen therapy 4) using drugs to treat arrhythmias (abnormal heart rhythms).

The ACLS guidelines are designed to help healthcare providers make rapid, informed decisions about the best way to treat a person in cardiac arrest.

Some of the key interventions included in ACLS are: providing oxygen to the patient, performing chest compressions, and using an automated external defibrillator (AED). Healthcare providers may also use medications such as adrenaline and atropine to help support the patient's heart function.


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