Advanced Life Support

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Advanced life support is the extension of basic life support using additional skills like advanced airway management, defibrillation, and intravenous access and drug therapy. The same reason why competency in Basic Life Support is a requirement in taking any advanced life support course. Healthcare professional like physicians, nurses, EMTs and paramedics trained in ALS have the knowledge and skills needed in advanced resuscitation situations of someone suffering a life threatening emergency.

ALS Components

The essential components of advanced life support includes advanced airway management, defibrillation, transcutaneous pacing, rhythm recognition, post-resuscitation care, and drug administration.

Equipment

ALS requires tools and equipments similar to those found in emergency department and critical care unit like defibrillator, external pacemaker, EKG monitor, intravenous and other tools for drawing blood, prehospital drugs, portable oxygen system, and many more.

Advanced Life Support Algorithm

ALS continues where basic life support left off and assumes it is administered and is focused on monitoring the heart rhythm. When cardiac arrest is established, depending on the electrical activity of the heart and type of cardiac arrhythmia, defribillation is applied and medication is administered. The heart rhythm is assessed on a regular interval to determine the effect of the treatment.

During CPR, high quality CPR must be done, actions planned before interrupting, oxygen must be given, considering advanced airway, chest compressions when advanced airway is in place, vascular access, give adrenaline every 3-5 mins, and correcting reversible causes is done.

After the cardiac treatment, treating the cause, controlled oxygenation and ventilation, controlling the temperature is done on the individual.

Reversible Causes: H’s and T’s

The 4 H’s and 4 T’s are considered as potentially reversible causes of cardiac arrest. These are given to aid in remembering during CPR.

  • Hypoxia: low levels of oxygen in the blood
  • Hypovolaemia: low amount of blood circulating
  • Hypokalaemia / hyperkalaemia / metabolic: disturbances in levels of calcium, potassium, or magnesium in the blood
  • Hypothermia: below normal body temperature
  • Thrombosis – coronary or pulmonary: blocked blood vessels in heart or lungs
  • Tamponade – cardiac: blood or other fluid around the heart compressing it
  • Toxins: poisoning from chemicals or medication
  • Tension pneumothorax: oxygen shortage and low blood pressure from air leak in the lung

Advanced life support is included in the EMT training above the EMT Basic level and other skills can be acquired on continuing education courses. The guidelines can be found here(UK).

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