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ACLS Primary Assessment

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls ACLS Primary Assessment Airway (A) Maintain an open airway for unconscious patients. Techniques: Head tilt-chin lift or basic airway adjuncts (e.g., oropharyngeal, nasopharyngeal). Advanced airways (e.g., endotracheal tubes, laryngeal masks) if needed. Consider cost vs. benefits of advanced airway placement vs. interrupting chest compressions. If bag-mask ventilation is adequate, delay advanced airway insertion until necessary. Confirm proper placement using quantitative waveform capnography. Secure airway tube in place and continuously monitor placement. Breathing (B) Assess adequacy of ventilations and oxygenation. Administer 100% oxygen for arrest patients; titrate to achieve SpO2 above or equal to 94% for others. Monitor: Quantitative waveform capnography for CPR effectiveness. PetCO2 less than 10 mmHg: Indicates need to improve CPR quality. Intra-arterial diastolic pressure less than 20 mmHg: Reassess compression depth, rate, and hand placement. Circulation (C) Attach a monitor/defibrillator to identify arrhythmias or cardiac arrest rhythms: Ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity. Provide defibrillation/cardioversion as needed. Obtain IV/IO access for fluid and medication delivery. Administer appropriate drugs to manage rhythm and blood pressure. Give IV/IO fluids if indicated. Disability (D) Evaluate neurologic function quickly. Use the AVPU scale to assess responsiveness: A: Alert. V: Responds to Voice. P: Responds to Painful stimulus. U: Unresponsive. Check for pupil dilation, which may indicate brain death or viability. Exposure (E) Remove clothing for a thorough physical examination. Look for: Obvious trauma, bleeding, burns, or unusual markings. Medical alert bracelets or other identifiers. Ensure patient privacy and warmth while assessing. Subsequent Assessment Check glucose levels and temperature. Assess and correct perfusion if possible. Continuous assessment and action until patient is transferred to the next level of care. For unconscious patients in full arrest: Conduct after basic life support assessment. For conscious patients needing advanced care: Perform primary assessment first. High-performance teams often perform simultaneous actions during real ACLS codes.