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ADVANCED CARDIAC LIFE SUPPORT FOR THE EXPERIENCED PROVIDERS ADVANCED CARDIAC LIFE SUPPORT PROVIDERS COURSE PEDIATRIC ADVANCED LIFE SUPPORT PROVIDERS COURSE BASIC LIFE SUPPORT OVERVIEW OF 5 MODULES PEDIATRIC BASIC LIFE SUPPORT PROVIDERS COURSE HEARTSAVER PLUS PROVIDER COURSE BASIC LIFE SUPPORT FOR HEALTHCARE PROVIDERS AUTOMATED EXTERNAL DEFIBRILLATION PROVIDERS COURSE
ADVANCED CARDIAC LIFE SUPPORT FOR THE EXPERIENCED PROVIDERS Objectives The objectives of the ACLS Course for Experienced Providers (ACLS EP) are: Major
Minor
The combination of the ACLS Provider Course followed by the ACLS-EP Course will provide regular updates of knowledge and skills. The course we believe, will stimulate interest in "keeping up" and will help satisfy institutional requirements for regular continuing medical education, a requirement faced by clinicians and healthcare professionals yearly. Perhaps of greatest value, the course will generate greater interest in ACLS among persons who till now take one ACLS course but seldom if ever return for timely review. Sample ACLS-EP Course Schedule (8-10 hours) O800-0825 Welcome introduction The following four learning stations are based on (CEET) Cardiovascular emergencies, Electrolyte abnormalities, Environmental emergencies and Toxicologic emergencies. The Five Quadrads Approach Cardiac Arrest: Pre – Cardiac Arrest: Learning Station A Cardiovascular Emergencies Learning Station B Learning Station C Learning Station D Broad Learning Objectives The instructor let specific learning objectives guide their instruction at each case-management learning station. The course trains learners to return repetitively to the same system to manage and evaluate every case. Primary and secondary ABCD Surveys, expanded to include the Five Quadrads Approach. The course also teaches learners specific critical actions to take for specific critical problems Specific Learning Objectives At the end of this course the instructors should be sure that successful course participants are able to do the following:
Minimum Criteria for Successful Completion of the ACLS-EP Course A participant in the ACLS – EP Course will be considered to have
successfully completed the course if he or she Text required for participants ADVANCED CARDIAC LIFE SUPPORT PROVIDERS COURSE COURSE TIMETABLE ACLS COURSE SCHEDULE 10-11 HOURS Once the participant completes the written
examination, he or she joins a discussion group to review the
teaching points of missed questions.
Here are the core knowledge and skills needed for ACLS: For devices and procedures, participants must know * Indications (knowledge) * Precautions (knowledge) * Proper use (hands-on practice) For pharmacologic agents, participants must know * Why an agent is used (actions) * When to use an agent (indications) * How to use an agent (dosing) * What to watch out for (precautions) Airway management and endotracheal intubation (core), including: - Noninvasive airway techniques and devices (hands-on practice) - Rescue position - Nasal cannulas - Venturi masks - Oropharyngeal airways - Pocket face masks and barrier devices - Bag-valve mask - Tracheobronchial suctioning - Cricoid pressure - Techniques to administer oxygen (hands-on practice) - Oxygen tanks - Cricothyrotomy (supplemental) -Transtracheal catheter ventilation (supplemental) -Endotracheal intubation (hands-on practice) Recognition and therapy of the major ACLS emergency conditions (core): * Universal algorithm * Ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) * Pulseless electrical activity (PEA) * Asystole * Bradycardia * Tachycardias * Acute coronary syndromes * Hypotension/shock/acute pulmonary edema * Acute ischemic stroke Electrical therapy (core), including: Defibrillation with automated external defibrillators (AEDS) (hands-on practice) Defibrillation with conventional defibrillators (handson practice) Attachment of defibrillators (conventional and AED) as a cardiac monitor Electrical cardioversion with conventional defibrillators Transcutaneous pacemakers (hands-on practice) -Asynchronous pacing Synchronous pacing Intravenous (IV) and invasive therapeutic and monitoring techniques, including: Peripheral IV lines (core) Hand, antecubital, saphenous, external jugular, femoral Central IV lines (supplemental) Internal jugular (Seldinger technique and triplelumen catheters) Subclavian Pericardiocentesis (supplemental) Thoracentesis for tension pneumothorax (supplemental) Recognition of the following rhythms (core): * Lethal rhythms VF / VT Artifact from lead detachment, movement, electrical interference Asystole PEAs (narrow-complex and wide-complex) Nonlethal arrhythmias Normal sinus rhythm Bradycardias: sinus bradycardia, atrioventricular (AV) nodal blocks (first-,second- [type 1 and type Ill, third-degree) Atrial tachycardia, atrial tachycardia with block, atrial flutter with various degrees of block, premature ventricular complexes (PVCS) Tachycardias: sinus tachycardia, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), wide-complex tachycardias Electrocardiographic (ECG) criteria for acute ischemia, acute injury, acute infarction (anterior, inferior) Pacemaker spikes ACLS cardiovascular pharmacology (core), including the Why? (actions), When? (indications), How? (dosing), and Watch out! (precautions) of the following agents: * Electricity * Oxygen * Epinephrine * Lidocaine * Bretylium * Magnesium sulfate * Procainamide * Sodium bicarbonate * Atropine * Dopamine *. lsoproterenol * Vagal maneuvers (used as a drug) * Adenosine * Verapamil * Diitiazem * p-Blocker (eg, atenolol, propranolol, or metoprolol) * Nitroglycerin * Nitroprusside * Dobutamine * Morphine sulfate * Furosemide * A thrombolytic agent (the one used in the provider's work setting) Stroke management Evaluation Stations
PEDIATRIC
ADVANCED LIFE SUPPORT PROVIDERS
COURSE The course timetable and content will depend on the target audience. Some groups will be more advanced than others; the core material may be tailored to meet the needs of the audience. Several schedule templates can be provided to show options in course sequence and weighting material. The course director may choose the schedule that best suits the target audience. Template Total teaching time: 6 hours, 20 minutes Overview and evaluation of the PALS Program The goals of the Pediatric Advanced Life Support Course are to provide the
participant with:- The course is intended for healthcare providers who are responsible for the well-being of infants and children - pediatricians, house staff, emergency physicians, family physicians, nurses, paramedical personnel, respiratory therapists, and others. Innovative teaching methods that meet the needs of the participants are encouraged. Lecture time is minimal so that hands-on experience is emphasised. Technical skills and information are first taught separately in 1 hour small-group sessions. Practical application of skills and knowledge in critical situations is then emphasised in case presentations, first in large group discussions called "integration sessions" and then at small-group teaching and evaluation stations. Course Synopsis Lecture: Recognition of Respiratory Failure and Shock and Prevention of Cardiopulmonary Arrest This lecture presents the antecedents of cardiopulmonary arrest, including the presenting signs and symptoms that suggest risk, and reviews how to perform a rapid cardiopulmonary assessment. The primary objective of this lecture is to enable the participant to identify a child at high risk and to prevent cardiopulmonary arrest. Lecture: Fluid Therapy and Medications This lecture presents fluid therapy and drugs used in resuscitation. It is
not intended to be a detailed discussion of the pharmacology of resuscitation
drugs. Instead, it briefly reviews the drugs used in cardiopulmonary
resuscitation, their indications and contraindications. Skills Stations Four (4) skills stations are offered simultaneously and are repeated so that each participant will rotate through all four 60-minute stations in 4 hours. The skills stations are designed to provide participants the opportunity to master skills essential to the stabilisation of seriously ill or injured newborns, infants, or children. Skills stations should not be devoted to didactic lecture. Instead, they should involve the participants in return demonstrations after brief comments or demonstration by the instructor. Skills Station 1: Basic Life Support and Bag-Valve-Mask Ventilation. The steps in basic life support for infants and children are reviewed using manikins, and the participant is given the opportunity to demonstrate each step separately and to integrate each step into a resuscitation sequence. The scientific rationale for each step is provided. Bag-valve-mask ventilation is discussed, demonstrated, and practiced. Skills Station 2: Advanced Airway Management. Discussions, demonstrations, and practice teach the participant how to use airway adjuncts, endotracheal tubes, stylets, laryngoscopes, and suction catheters and how to provide lip retraction and cricoid pressure. Manikin heads and anesthetized live animals (optional) will be used. Each participant should have ample opportunity to practice. Skills Station 3: Vascular Access. Participants learn a sequential approach to establishment of vascular access during resuscitation. Peripheral venous cannulation is stressed, and the intraosseous technique is presented as an important method of administering drugs and fluids. Participants practice intraosseous needle placement on chicken bones. Skills Station 4: Cardiac Rhythm Disturbances. Participants learn a practical approach to recognition of rhythm disturbances and have the opportunity to identify abnormal rhythms and determine their hemodynamic effects. Indications for and methods of cardioversion and defibrillation are reviewed, and drug therapy is presented. The material may be presented in a largegroup lecture or a skills station. Integration Session: Case Studies in Respiratory Failure and Shock The integration sessions give participants an opportunity to
interact with the instructor in a case presentation format applying the
knowledge acquired from the text and the skills stations. Recognition of shock
and respiratory failure is reemphasised, and management priorities (airway,
vascular access, fluids, resuscitation drugs, and frequent patient
reassessments) are highlighted. Lecture: Newborn Resuscitation Outside the Delivery Room This lecture concentrates on the preparation for and priorities of newborn resuscitation outside the delivery room. Fundamental therapies include airway management, warming, stimulation, suctioning, chest compressions, and medications. Lecture: Trauma This lecture emphasises the specific principles of airway, ventilation, fluid management, and support of perfusion for the trauma patient. This lecture is not a comprehensive discussion of trauma care but emphasizes management of the airway and treatment of shock in the injured child. Teaching Stations The four teaching stations are offered simultaneously and repeated so that the participant will rotate through all four 45-minute teaching stations in 3 hours. The teaching stations are designed to enable participants to practice assignments and interventions needed to recognise and treat cardiopulmonary deterioration in newborns, infants, and children. Instructors should use equipment to emphasise essential information. These teaching stations should give participants the opportunity to act through the scenarios. Participants should be involved in handling equipment and assessing" and "treating" the manikin as quickly as possible. Didactic lecture is not appropriate. Involvement of each participant is essential. Teaching Station 1: Newborn Resuscitation. The case format is used to allow participants, in small groups, to apply their knowledge and psychomotor skills in the resuscitation of the newborn by responding to scenarios offered by the instructor. The basic principles of newborn resuscitation are stressed. T eaching Stations 2, 3, and 4: Respiratory Failure, Shock, and Cardiopulmonary Arrest/Cardiac Rhythm Disturbances. In these sessions participants apply their knowledge and psychomotor skills in treating the pediatric patient in cardiopulmonary arrest, shock, or respiratory failure. Small groups of participants are expected to respond to scenarios given by the instructor and to demonstrate resuscitation using manikins, intubation heads, intravenous fluids, and drugs. The cases are discussed with the group, and key teaching points are highlighted.Integration Session: Case Studies in Postarrest Stabilization and Transport Cases are presented that stress the principles of postresuscitation
stabilization, airway and fluid management, and monitoring. Appropriate
transport for ongoing care also is discussed. Participants are expected to
discuss the case presentations. Evaluation Stations
The three evaluation stations are offered simultaneously and repeated so that each participant finishes all three 45-minute stations in 2 hours, 15 minutes. The participants, in small groups, test their knowledge and psychomotor skills by responding to case scenarios with the performance of resuscitation on a manikin using appropriate techniques. The procedures and therapies are recorded in the sequences in which they occur, and each participant is critiqued on his or her performance. The scenarios include cases of respiratory failure, shock, and cardiopulmonary arrest in the newborn, infant, and child. A written evaluation assesses the participant's knowledge of the text and the course material. Participants will be asked to complete and turn in the course evaluation at the end of the written evaluation. Back to COURSE SYNOPSIS:
BASIC LIFE SUPPORT OVERVIEW OF 5 MODULES Unit 1: Heartsave Providers Course Module 1 BLS Provider Course Outlines The following outlines are suggested for the five BLS units / modules. The subject matter may be arranged to accommodate the needs of individual classes. The material taught should be geared to the age and education of the learners, and an outline should be followed. A course curriculum comprises one or more instructional modules plus additional information specific to the topic (eg, the PBLS course includes expanded information on injury prevention). Each course should be modified as needed for a specific audience.
Available Curricula Five courses and five modules are available to the instructor and learner. They comprise a collection of information commonly used by experienced instructors. Each curriculum is designed for a specific audience and includes information and performance guidelines to help that audience learns commonly needed skills. Each course is composed of between one and five instructional modules to enable instructors and learners to work with logical blocks of information. All BLS courses should emphasise the principles and practices of primary
prevention, i.e., preventing cardiovascular diseases or other causes of cardiac
and respiratory arrest.
Unit 2 Module 2: Pediatric BLS 4 – 6 hours Educators, parents of
infants and children,day-care personnel, The EMS system CPR and Relief of
FBAO Unit 3 Heartsaver Plus Module 1: Adult One-Rescuer, Module 2: Pediatric BLS Module 4: Use of barrier devices Whoms job requires a CPR and Relief of FBAO 6 – 8 hours Written evaluation and a Course completion card Unit 4 Healthcare providers Module 1: Adult One-Rescuer Module 3: Adult Two-Rescuer CPR* Module 4: Barrier Devices Module 5 Unit 5 Evaluation Station Criteria for Successful Course Completion Pass-fail written and practical examinations are not part of the Heartsaver or PBLS courses. However, instructors should evaluate each student and provide feedback to participants on skills performance to allow each person to achieve the maximal level of proficiency. For satisfactory course completion, healthcare provider students are required
to The written examination must be the international AHA BLS written evaluation. Adequate time and space must be provided for the evaluation, and the instructor should plan to review it after completion. The evaluation of manikin performance must be conducted in an area separate from that used for practice. If there are many participants, all the manikins may be used for the early portion of practice. As participants become ready for evaluation, one or two manikins should be set aside for that purpose. The instructor should be joined by a second instructor, if possible, to assist in evaluating two-rescuer CPR. Adequate floor or knee padding should be provided for participant comfort. Under certain circumstances, manikins may be placed on tables or beds with bedboards. Back to COURSE SYNOPSIS:
Unit 1: Heartsaver Providers Course Module: 1 Heartsaver Provider Course The Heartsaver curriculum consists of the adult one rescuer CPR module, including relief of FBAO. Risk factors, prudent heart living (prevention), signs and signals for action, the chain of survival concept, and the warning signs and risk factors for stroke are included in this course. The Heartsaver Course is appropriate for most lay rescuers. Most learners can complete instruction and practice in about 4 hours. No skills testing or written examination may be given, and course completion cards must not be issued for this course. A course participation card should be issued to all learners regardless of their level of activity in the course. Additional information may be added to the Heartsaver Course, such as the module on barrier devices. Pediatric CPR and FBAO skills (Module 2) also may be added. The final decision about course content rests with the course director. Regardless of which additional information or BLS modules are added to the Heartsaver Course, the course participation card will reflect only the Heartsaver name. Module 1: Adult One-Rescuer CPR Relief of Adult Foreign-Body Airway Obstruction Skills Adult Airway Obstruction The technique of finger sweep is desirable but not critical. However, some effort to remove material from the mouth should occur. An absolute number of abdominal thrusts is not critical, but some interspersion of abdominal thrusts and ventilation attempts is necessary. Participants must receive remediation until they complete each skill on all the skill sheets. This may be accomplished in a single course or may require multiple courses. Healthcare providers should be able to complete all the steps in order without coaching. EVALUATION STATION Criteria for Successful Course Completion Pass-fail written and practical examinations are not part of the Heartsaver
or PBLS courses. However, instructors should evaluate each student and provide
feedback to participants on skills performance to allow each person to achieve
the maximal level of proficiency. Adult CPR The goal of CPR training is not to produce a "perfect manikin strip" but rather to understand and gain the broad psychomotor skills necessary to perform this lifesaving technique.
PEDIATRIC BASIC LIFE SUPPORT PROVIDERS COURSE
Unit 2: Pediatric BLS Providers Course Module: 2 Most participants will be able to complete instruction and practice in about 6 hours. Module 2: Pediatric One-Rescuer CPR Relief of Pediatric Foreign-Body Airway Obstruction A. Introduction EVALUATION STATION Criteria for Successful Course Completion Pass-fail written and practical examinations are not part of the Heartsaver or PBLS courses. However, instructors should evaluate each student and provide feedback to participants on skills performance to allow each person to achieve the maximal level of proficiency. In pediatric BLS courses, the general guidelines for evaluation are similar to those used in adult BLS courses. The instructor should remember that cardiorespiratory emergencies in children are usually caused by respiratory difficulties, so the focus of pediatric BLS should be on respiratory support. The major difference in the sequence of BLS skills is the provision of approximately 1 minute of rescue support to pediatric victims before activation of the Emergency Medical System. In addition, because normal heart and respiratory rates are higher for children than adults, more rapid rates of compression, ventilation, and rescue breathing should be provided.
HEARTSAVER PLUS
PROVIDER COURSE Heartsaver Plus Course T he Heartsaver Plus curriculum is designed for people who serve as first responders to cardiac emergencies in the workplace or other environment outside a hospital. It discusses the chain of survival, early recognition of a heart attack, and management of the victim who is experiencing a heart attack but is not in cardiac arrest. It covers rescue breathing, Module 1,Adult One-Rescuer CPR (including foreign body airway obstruction), Module 2, Pediatric One-Rescuer CPR and Module 4, Barrier devices.The course includes information on barrier devices for use with victims who have stopped breathing, who have an obstructed airway, or who are in cardiac arrest.The course requires a written evaluation, and course completion cards are issued to those successfully completing the course. The time allotted must be sufficient for appropriate review of content and participant practice and demonstration of skills. Acquisition of skills is a major goal of each course, so the emphasis should be skill-based with plenty of opportunity to practice and demonstrate the skills of pediatric and adult CPR. Expected time 6 to 8 hours. Module 1: Adult One-Rescuer CPR Relief of Adult Foreign-Body Airway Obstruction Module 2: Pediatric One-Rescuer CPR Relief of Pediatric Foreign-Body Airway Obstruction A. Introduction Module 4: Barrier Devices Skills: Airway Obstruction The technique of finger sweep is desirable but not critical. However, some effort to remove material from the mouth should occur. An absolute number of abdominal thrusts is not critical, but some interspersion of abdominal thrusts and ventilation attempts is necessary. Participants must receive remediation until they complete each skill on all the skill sheets. This may be accomplished in a single course or may require multiple courses. Healthcare providers should be able to complete all the steps in order without coaching. In pediatric BLS courses, the general guidelines for evaluation are similar to those used in adult BLS courses. The instructor should remember that cardiorespiratory emergencies in children are usually caused by respiratory difficulties, so the focus of pediatric BLS should be on respiratory support. The major difference in the sequence of BLS skills is the provision of approximately 1 minute of rescue support to pediatric victims before activation of the EMS system. In addition, because normal heart and respiratory rates are higher for children than adults, more rapid rates of compression, ventilation, and rescue breathing should be provided. Evaluation Station The criteria for Heartsaver Plus course completion are as follows:
BASIC LIFE SUPPORT FOR HEALTHCARE PROVIDERS Unit 4: BLS for Healthcare Providers Modules 1,2,3,4,5 Basic Life Support for Healthcare The course is appropriate for professional healthcare providers, such as physicians, nurses, and EMTS. The course must be successfully completed by lay rescuers interested in becoming BLS instructors. Most participants need 8 hours of instruction and practice to complete the course satisfactorily for the first time and 2 to 4 hours of review and practice to bring knowledge and skills to previous proficiency during retraining. The BLS curriculum and evaluation for healthcare providers comprises modules on adult one-rescuer CPR, adult two-rescuer CPR, pediatric one-rescuer CPR, and barrier devices. All persons participating in a BLS healthcare provider's course must be trained in the use of a mask with a one-way valve (non rebreathing valve) for instruction in rescue breathing and in mouth-to-mouth ventilation. A written evaluation and manikin skill evaluation are part of this course. Successful course completion cards may be given to students who meet the criteria as described. The module for automated external defibrillation can be added when the use of AEDs is part of the provider's role. Unit 1: Heartsaver Provider Course Module: 1 Unit 2: Pediatric BLS Provider Course Module: 2 Module 3: Adult Two Rescuer CPR Module 4: Barrier Devices
Module 5: Automated External Defibrillation (optional) for more detail see Unit 5 Module This Module may be used on its own as Heartsaver AED program At the end of the course the student must demonstrate competency in a practical evaluation of managing cardiac arrest using automated defibrillation according to the guideline protocols. The practical evaluation has five objectives: The student must demonstrate control of the emergency scene and direct resuscitation efforts. A written evaluation, requires the student to demonstrate knowledge of local standing orders/protocols about use of AEDs and local program requirements. Evaluation Station BLS Healthcare Provider Course The criteria for healthcare provider course completion are as follows: AUTOMATED EXTERNAL DEFIBRILLATION PROVIDERS COURSE Unit 5: Heartsaver AED Module: 5 Defibrillation training Course Agenda Introduction 30 minutesWelcome and introduction 5 minutes Overview video: EZ AED 10 minutes Overview of the chain of survival and automated defibrillation 15 minutes Sudden Cardiac death Chain of Survival Importance of early defibrillation What is an AED How does an AED work? Instruction in CPR and Relief of Foreign Body Airway Obstruction 1 hour 15 minutes Watch-then-practice: mouth to mouth breathing 15 minutes Watch-then-practice: mouth to mask breathing 15 minutes Watch-then-practice: chest compressions 15 minutes Watch-then-practice: CPR (mouth to mask plus chest compressions) 15 minutes Watch-then-practice: relief of FBAO (clearing the obstructed airway in 15 minutes the conscious and unconscious victim) Break AED Instruction 30 minutes Instructor demonstrates operation and maintenance of AED 15 minutes Turning device on Skin preparation Location of pads Pad placement Analyze mode Delivery of shock No shock indicated Instructor demonstrates one-rescuer AED scenario: 1 shock; pulse and breathing return Participants practice HeartSaver AED algorithm (single – shock scenario)15 minutes Scenario-based Practice 35-45 minutes Practice and review: 8 critical scenarios (groups of 4: 8 rotations) 45 minutes Practical Evaluation 25-40 minutes Practical evaluation 20 minutes Written evaluation 20 minutes Total time: 3½ to 4 hours Evaluation Station Training in the Use of Automated External Defibrillators course Objectives At the end of the course the student must demonstrate competency in a practical evaluation of managing cardiac arrest using automated defibrillation according to the guideline protocols. The practical evaluation has five objectives: The student must demonstrate control of the emergency scene and direct resuscitation efforts. The student must demonstrate adherence to the recommended protocols in a simulated cardiac arrest while correctly defibrillating a manikin within 90 seconds (or preferably less) of arrival at the manikin's side. The student must demonstrate safe use of the AED; answer questions about controls, disposable supplies, and maintenance; and demonstrate troubleshooting techniques. The student may be required to provide appropriate voice documentation of events on the scene if the device contains a voice recorder. The student must demonstrate appropriate assessment and care of the patient before, during, and after defibrillation. A written evaluation, requires the student to demonstrate knowledge of local standing orders/protocols about use of AEDs and local program requirements.
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