Advanced life support

Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing). Key aspects of ALS level care include: Tracheal intubation Rapid sequence induction Cardiac rhythm monitoring by ECG Cardioversion and defibrillation using a manual or automated external defibrillator Transcutaneous pacing Ultrasonography Intravenous cannulation (IV) Intraosseous (IO) access and intraosseous infusion Surgical cricothyrotomy Needle cricothyrotomy Needle or finger thoracostomy of tension pneumothorax Pericardiocentesis Advanced medication administration through parenteral and enteral routes (IV, IO, PO, PR, ET, SL, topical, and transdermal) Advanced cardiac life support (ACLS) Pediatric Advanced Life Support (PALS) or Pediatric Education for Pre-Hospital Providers (PEPP) Pre-Hospital Trauma Life Support (PHTLS), Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS) In cases of cardiac arrest, ALS builds on the foundations of basic life support (BLS) interventions such as bag-mask ventilation with high-flow oxygen, chest compressions, and use of an AED. The core algorithm of ALS that is invoked when cardiac arrest has been confirmed, Advanced Cardiac Life Support (ACLS), relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation and/or medication may be administered. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effectiveness of the interventions on the heart rhythm, as well as the presence of cardiac output, is assessed. Medications that may be administered include adrenaline (epinephrine), amiodarone, atropine, bicarbonate, calcium, potassium and magnesium, among others. Saline or colloids may be administered to increase the circulating volume.