Advanced life support
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2008-07-16T00:28:45Z
Medicellis
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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}}
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