# Advanced Cardiac Life Support

## Overview

This module describes how to perform Advanced Cardiac Life Support (ACLS) to resuscitate a patient in cardiac arrest.

## Indications

## Contraindications

## Patient information and consent

This procedure is done when a patient is in cardiac arrest, so consent is generally implied. However, check for “Do Not Resuscitate” (DNR) orders, “Not For Max” orders, or living wills that specify that no resuscitation may be performed.

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## Preparation

Manual defibrillation is an emergency procedure. Always:

## Site & Positioning

To perform Advanced Cardiac Life Support, a patient should be lying flat on their back on a firm surface. There should be space behind the head of the bed for staff to give rescue breaths.

## Procedure

Use medical asepsis with non-sterile gloves.

While performing CPR:

## Troubleshooting

I’m unsure about the quality of my chest compressions.

Check the following:

I’m unsure about the quality of my rescue breaths.

Ensure correct head position. Consider using an oropharyngeal or nasopharyngeal airway. Ensure that you are pulling the face into the mask using an EC grip, rather than leaning on the patient’s face. Continuously monitor chest rise.

My patient is moving but I still can’t find a pulse.

Patients in cardiac arrest may have movements such as twitching or writhing. If there is no pulse and the patient is not responding to your prompts, continue CPR.

I heard something crack under my hands.

Rib and sternal fractures are not uncommon. Continue CPR, but ensure your hand placement is correct.

## Risks

## References