Advanced Cardiac Life Support, or ACLS, is a life-saving skill set in which trained and certified personnel administer interventions to a person in cardiac arrest or other cardiopulmonary emergencies. The American Heart Association (AHA), the recognized authority for ACLS in healthcare, trains emergency personnel in the 12-hour ACLS Provider course to use drugs, CPR, oxygen and defibrillation with situation-specific algorithms.
Adenosine
Adenosine converts an extremely high and dangerous heart rhythm (tachycardia) to normal sinus rhythm. When the heart beats extremely fast, it is merely quivering and unable to pump oxygenated blood throughout the body. Adenosine calms the heart muscle, enabling proper filling of the ventricles and restores adequate perfusion to the rest of the body.
Amiodarone
With a life-threatening high heart rate of more than 200 beats per minute (known as ventricular fibrillation or ventricular tachycardia), amiodarone is used to return the heart to normal sinus rhythm when epinephrine or vasopressin have been ineffective.
Atropine
When the heart beats too slowly (known as bradycardia), atropine acts on the SA and AV nodes inside the heart to stimulate electrical activity causing the heart to beat faster, as stated in "Mosby's Nursing Drug Reference."
Dopamine
In cases where the heart beats too slowly and a noticeable blue tinge appears in the fingertips, toes and around the mouth--an indication of poor perfusion--a single dose of dopamine may be administered after attempting correction with atropine.
Epinephrine
Epinephrine plays a part in every possible heart rhythm in the ACLS algorithm with the exception of tachycardia. Epinephrine restores cardiac rhythm in cardiac arrests. Most often epinephrine is used as the first line of defense against irregular rhythms.
Lidocaine
After trying to bring the heart rate down from a life-threatening high with epinephrine, vasopressin or amiodarone, lidocaine may be given. According to the "PDR Nurse's Drug Handbook," lidocaine treats ventricular arrhythmias caused by heart attack by decreasing the excitability of the ventricles located inside the heart.
Magnesium
A rhythm of "torsades de pointes," which can only be determined by a specific rhythm viewed on a heart monitor, is the only event in the ACLS protocols which permits use of magnesium. Torsades is a very high heart rate that may be unresponsive to epinephrine, vasopressin, amiodarone or lidocaine.
Vasopressin
Classified as a pituitary hormone, vasopressin acts to constrict blood vessels in cardiac tissue during the life-threatening high heart rates of ventricular fibrillation or ventricular tachycardia. Vasopressin can only be given one time in the v-fib or v-tach algorithm due to the possibility of it causing further cardiac damage.
References
- American Heart Association
- "ACLS Resource Text"; American Heart Association; 2008
- "PDR Nurse's Drug Handbook 2010"; Thomson Reuters and Alexander Ivy; 2009
- "Mosby's 2010 Nursing Drug Reference"; Linda Skidmore-Roth, 2009
