Describe Advanced Life Support & Arrest Rhythms in detail.

Advanced Life Support

Advanced (cardiac) life support (ALS/ACLS) builds on BLS with a defibrillator, drugs, advanced airway and treatment of reversible causes. The team continues high-quality CPR while the rhythm is assessed and classified as shockable or non-shockable, which determines the pathway.

Cardiac-arrest rhythms split into shockable (VF/pulseless VT → defibrillate) and non-shockable (pea/asystole → CPR + adrenaline); both need CPR, adrenaline and correction of the reversible causes.

Shockable VS Non-shockable

Shockable rhythms — ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) — are treated with immediate defibrillation and CPR; adrenaline and amiodarone are added for refractory cases. Non-shockable rhythms — pulseless electrical activity (pea) and asystole — are not shocked; they are treated with CPR and adrenaline, with the focus on finding and treating a reversible cause.

Drugs & Reversible Causes

• Adrenaline is given every 3–5 minutes (immediately in non-shockable arrest; after the third shock in shockable).
• Amiodarone is given for shock-refractory VF/VT. Throughout, the team searches for and treats the reversible causes — the ‘4 Hs and 4 Ts’: Hypoxia, Hypovolaemia, Hypo-/hyperkalaemia (& metabolic), Hypothermia
• Tension pneumothorax, Tamponade, Toxins, Thrombosis (coronary/pulmonary).

Advanced Airway & Team Working

During advanced life support the airway is secured — by a supraglottic device or tracheal intubation — to allow continuous chest compressions without the pauses needed for mouth-to-mask or bag-mask ventilation, and continuous waveform capnography is used to confirm tube placement, to gauge the quality of compressions, and to detect the return of spontaneous circulation as a sudden rise in end-tidal carbon dioxide. Equally important is good team working: a team leader coordinates the resuscitation, allocates roles, keeps track of the cycles of CPR and rhythm checks and the timing of drugs, and ensures the reversible causes are being addressed, because a well-led, well-drilled team delivers the high-quality, minimally-interrupted CPR on which outcome depends.

• ALS = BLS + defibrillator, drugs, advanced airway, treating reversible causes; assess rhythm as shockable/non-shockable.
• Shockable (VF, pulseless VT) → defibrillate + CPR; adrenaline & amiodarone if refractory.
• Non-shockable (pea, asystole) → CPR + adrenaline (no shock); focus on reversible cause.
• Adrenaline every 3–5 min; amiodarone for refractory VF/VT.
• Reversible causes — 4 Hs (hypoxia, hypovolaemia, hypo/hyperkalaemia, hypothermia) & 4 Ts (tension pneumothorax, tamponade, toxins, thrombosis).