Please help! ACLS :/

1) when do you start ACLS-i.e., when does BLS turn into ACLS?

Basic life support should never "turn into" ACSL; rather, ACLS interventions should be added to ongoing BLS. While this might seem like semantics, it's not. Many providers seem to think that the addition of ACLS, or PALS in the pediatric population lessens the need for good BLS. In my opinion, when we talk about this conversion, it deemphasizes the role that BLS plays in ACLS and the ongoing resuscitation.

2) what, technically, is cardiac arrest? Sounds dumb, but I haven't found a standard definition. Could somebody please define it?

The AHA defines cardiac arrest as "...the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. The time and mode of death are unexpected. It occurs instantly or shortly after symptoms appear." While there might be a more medically or technically precise term, I think this one works well in most discussions.

3) So, with cardiac arrest, it says that you should check rhythm, if VF or pulseless VT, shock,give CPR while establishing IV/ IO access,check the rhythm, and if still shockable, shock, give CPR, and then give epi q3-5 mins. So, for the CPR, should you give 5 cycles (2 mins) and then the epi? Also, it says to give epi q3-5 mins, but for how long? I've been doing practice questions, and I get confused because if the patient has been unresponsive to epi, how many more 1-mg doses should you administer before you move to amiodarone? I hope that this makes sense.

Initiate BLS first. Then, when the AED or manual defibrillator, if you are trained in its use, arrives, check for a shockable rhythm. If a shockable rhythm is detected, continue BLS while applying the pads and charging the defibrillator, and shock when charged. If you have sufficient manpower, someone can be working on vascular access while BLS is ongoing, however this should not be attempted if effective CPR is going to be compromised.

The general sequence, after initiation and the first defibrillation if indicated should be: 2 minutes of BLS, rhythm check, intervention, and repeat the cycle. The upcoming interventions should be based upon the last identified rhythm, and should always include defibrillation if appropriate. For instance, you initiate BLS, identify ventricular fibrillation and defibrillate, and resume BLS. If, at the next rhythm check, the patient remains in ventricular fibrillation, you would defibrillate, resume BLS, and administer epinephrine. Again, defibrillate if indicated and resume BLS. At this point, as you have attempted defibrillation three times, administration of amiodarone would be appropriate.

Epinephrine can be administered 3 – 5 minutes throughout the duration of the resuscitation, which, considering the 2 minute cycle of BLS would be every second rhythm check.

4) Also, when you're performing CPR, is it always for 5 cycles (2 minutes)?

As a general rule, yes. If you are using an AED, it should prompt you to hold CPR after 2 minutes while a rhythm check is completed. However, when the physician team leader arrives don't be surprised if he or she deviates from this.

Im just very overwhelmed with this, and want to make sure that I get the hang of it.im a new grad, and really have never seen a code. So, I'm pretty lost

Yes, if you've never witnessed or participated in resuscitation it can be quite overwhelming. If you have an opportunity to observe a code, do so. As a new nurse, you might find it helpful if you have an opportunity to serve as recorder. Don't fall into the trap of thinking that this is an easy job, however. In my opinion, the recorder is the second most important position behind that of the team leader. Obviously, as the team leader, you should be maintaining a detailed record of events. You should also be watching the clock and advising the team leader on time, and possible upcoming interventions.

There are two important things to remember. First, you will never be alone in working a cardiac arrest. And second, resuscitation is a team event. You will find that when a code occurs, most, if not all of your team members are going to show up. If you were the patient's primary nurse that shift, you are going to be expected to provide the details of what happened, but are not going to be expected to guide the resuscitation.

If you are interested in, the AHA updates the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science every 5 years, and these updates are the basis for the current ACLS, BLS, and PALS course materials, and are available online. The most recent update was undertaken in 2015. As not all aspects were addressed in this revision, you might also need to refer to the 2010 updates as well.

Thank you very much for taking the time to respond. I had downloaded an app, that had the algorithm, but it was pretty overwhelming. Thank you!

Uninterrupted, early and effective chest compressions is what ultimately saves people that can be saved.