Advanced life support 1811880 225917437 2008-07-16T00:28:45Z Medicellis 7129128 fixing links {{CIA}} [[Image:Rescue 28 of PBCFR.JPG|right|thumb|300px|A typical ALS Rescue Unit of [[Palm Beach County Fire-Rescue]] used for [[Emergency medical services|EMS]] in [[Palm Beach County, Florida]].]] '''Advanced Life Support''' (ALS)- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate) or an EMT-P (Paramedic), commonly referred to simply as a [[paramedic]] or [[medic]]. Canadian paramedics may be certified in either ALS or in only basic life support (see [[paramedics in canada]]). ALS (in most cases) refers to the skills and knowledge that a practitioner possess. The ALS provider may perform advanced procedures and skills on a patient involving [[invasive]] and non-invasive procedures including; * [[Cardiac]] Monitoring * [[Cardiac Defibrillation]] * [[Transcutaneous pacing]] * [[Intravenous cannulation]] (IV) * Iinterosseous (IO) access and[[ Intraosseous infusion]] * [[Surgical Cricothyrotomy]] * [[Needle Cricothyrotoy]] * [[needle decompression]] of [[Tension Pneummothorax]] * Advanced [[medication]] administration through [[parental]] and [[enteral]] routes (IV, IO, PO, PR, ET, SL, topical, and transdermal) * Following protocols as set forth by AHA [[Advanced Cardiac Life Support]] (ACLS) * Following protocols as set forth by AHA [[Pediatric Advanced Life Support]] (PALS) * Following protocols as set forth by [[Pre-Hospital Trauma Life Support]] (PHTLS) ==ALS Terminology== In the United States, Intermediate and Paramedic level services are referred to as Advanced Life Support. Services staffed by basic EMTs are referred to as [[Basic Life Support]]. This terminology extends beyond emergency cardiac care to describe all capabilities of the providers. ALS is a treatment consensus for [[cardiopulmonary resuscitation]] in [[cardiac arrest]] and related medical problems, as agreed in Europe by the [[European Resuscitation Council]], most recently in [[2005]]. It is practiced by in-[[hospital]] cardiac arrest teams, which generally consist of junior doctors from various specialties ([[anesthetics]], [[general medicine|general]] or [[internal medicine]]). [[Emergency medical technician]]s (EMTs) are often skilled in ALS, although they may employ slightly modified version of the algorithm. ==ALS algorithm's== ALS presumes that [[basic life support]] (bag-mask administration of [[oxygen]] and chest compressions) are administered. The main algorithm of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the [[heart]] on a cardiac monitor. Depending on the type of [[cardiac arrhythmia]], [[defibrillation]] is applied, and [[medication]] is administered. [[Oxygen]] is administered and [[endotracheal intubation]] may be attempted to secure the airway. At regular intervals, the effect of the treatment on the heart rhythm, as well as the presence of [[cardiac output]], is assessed. Medication that may be administered may include [[adrenaline]] (epinephrine), [[amiodarone]], [[atropine]], [[bicarbonate]], [[calcium in biology|calcium]], [[potassium]] and [[magnesium]]. [[Saline (medicine)|Saline]] or colloids may be administered to increase the circulating volume. While CPR is given (either manually, or through automated equipment such as [[AutoPulse]]), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as "6H's & 6T's" according to the new 2005 AHA ACLS <ref>http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58</ref><ref name=ACLS_2003_H_T>''ACLS: Principles and Practice''. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.</ref><ref name=ACLS_2003_EP_HT>''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.</ref><ref name="ECC_2005_7.2">"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.</ref> ==H's== * [[Hypoxia (medical)|Hypoxia]] (low oxygen levels in the blood) * [[Hypovolemia]] (low amount of circulating blood, either absolutely due to blood loss or relatively due to [[vasodilation]]) * [[Hyperkalemia]] or [[hypokalemia]] (disturbances in the level of [[potassium]] in the blood) and related disturbances of [[calcium in biology|calcium]] or [[magnesium]] levels and [[hypoglycemia]] (low [[glucose]] levels). * [[Hypothermia]] (body temperature not maintained) * [[Hydrogen|'''H'''ydrogen]] ions ([[Acidosis]]) * [[Hyperglycemia]] or [[Hypoglycemia]] - High or Low blood glucose levels ==T's== * [[Tension pneumothorax]] (tear in the lung leading to collapsed lung and twisting of the large blood vessels) * [[Cardiac tamponade|Tamponade]] (fluid or blood in the [[pericardium]], compressing the heart) * [[Poisoning|Toxic]] and/or [[medication|therapeutic]] (chemicals, whether medication or poisoning) * [[Pulmonary embolism|Thromboembolism]] and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a [[thrombus|blood clot]] or other material) * [[Tablets]] or [[Toxins]] - Ingestion or consumption of medications that have anti-dotes such as [[Tricyclic antidepressants]], [[phenothiazines]], [[beta blockers]], [[calcium channel blockers]], [[cocaine]], [[digoxin]], [[aspirin]], and [[acetominophen]]. * [[Thromboembolism]] ([[Pulmonary embolism]]). * [[Trauma]] ([[Hypovolemia]]) - Reduced blood volume. As of December 2005, Advanced 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]] is now administered as a single shock, each followed immediately by 2 minutes of [[CPR]] before rhythm is re-assessed (5 cycles of CPR). ---> see [[Advanced Cardiac Life Support]] ==Other conditions== ALS also covers various conditions related to cardiac arrest, such as [[cardiac arrhythmia]]s ([[atrial fibrillation]], [[ventricular tachycardia]]), [[poisoning]] and effectively all conditions that may lead to cardiac arrest if untreated, apart from the truly [[surgical emergency|surgical emergencies]] (which are covered by [[Advanced Trauma Life Support]]). ==References== {{reflist}} ==External links== * [http://www.resus.org.uk/pages/als.htm UK Resuscitation Council ALS page] * [http://www.cprsearch.com/ CPRSearch.Com - The CPR & ALS Training Directory] * [http://firstaid.about.com/od/glossary/g/07_als.htm About First Aid ALS Definition] {{Emergency medicine}} [[Category:Emergency medicine]] [[de:Advanced Life Support]] [[it:Supporto vitale avanzato]] [[pl:Reanimacja]]