Advanced Life Support (ALS) is a set of life saving protocols and skills that extend

basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be p ...

to further support the circulation and provide an open airway and adequate ventilation (breathing).

Components

These include: * Tracheal intubation * Rapid sequence induction *

Cardiac The heart is a muscular organ found in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon di ...

monitoring *

Cardiac defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...

not using an automated external defibrillator (AED) * Transcutaneous pacing * Ultrasonography *

Intravenous cannulation Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutri ...

(IV) * Intraosseous (IO) access and intraosseous infusion * Surgical cricothyrotomy *

Needle cricothyrotomy A cricothyrotomy (also called cricothyroidotomy) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or ...

* Needle or finger thoracostomy of tension pneumothorax * Pericardiocentesis * Advanced

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field an ...

administration through parenteral and enteral routes (IV, IO, PO, PR, ET, SL, topical, and transdermal) * Advanced cardiac life support (ACLS) * Pediatric Advanced Life Support (PALS) or Pediatric Education for Pre-Hospital Providers (PEPP) * Pre-Hospital Trauma Life Support (PHTLS), Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS)

Algorithms

ALS assumes that

(bag-mask administration of

oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as we ...

and chest compressions) are administered. The main

algorithm In mathematics and computer science, an algorithm () is a finite sequence of rigorous instructions, typically used to solve a class of specific problems or to perform a computation. Algorithms are used as specifications for performing ...

of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the

heart The heart is a muscular organ found in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon diox ...

on a cardiac monitor. Depending on the type of

cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the Cardiac cycle, heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per mi ...

, defibrillation is applied, and

is administered.

Oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as we ...

is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effect of the treatment on the heart rhythm, as well as the presence of cardiac output, is assessed. Medication that may be administered may include adrenaline ( epinephrine), amiodarone, atropine, bicarbonate,

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...

potassium Potassium is the chemical element with the symbol K (from Neo-Latin '' kalium'') and atomic number19. Potassium is a silvery-white metal that is soft enough to be cut with a knife with little force. Potassium metal reacts rapidly with atmosp ...

and

magnesium Magnesium is a chemical element with the symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 of the periodic ...

Saline Saline may refer to: * Saline (medicine), a liquid with salt content to match the human body * Saline water, non-medicinal salt water * Saline, a historical term (especially US) for a salt works or saltern Places * Saline, Calvados, a commune in ...

or colloids may be administered to increase the circulating volume. While CPR is given (either manually, or through automated equipment such as

AutoPulse The AutoPulse is an automated, portable, battery-powered cardiopulmonary resuscitation device created by Revivant and subsequently purchased and currently manufactured by ZOLL Medical Corporation. It is a chest compression device composed of a co ...

), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as "6Hs & 5Ts" according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS).''ACLS: Principles and Practice''. p. 71–87. Dallas: American Heart Association, 2003. .''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ."2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." ''Circulation'' 2005; 112: IV-58 – IV-66. Note these reversible causes are usually taught and remembered as 4Hs and 4TsResuscitation Council UK adult ALS algorithm 2005
—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation.

Hs and Ts

;'H's * Hypoxia: low oxygen levels in the body's tissues * Hypovolemia: low amount of circulating blood, either absolutely due to blood loss or relatively due to

vasodilation Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstricti ...

* Hyperkalemia or hypokalemia: disturbances in the level of

in the blood, and related disturbances of

levels. *

Hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...

Hyperthermia Hyperthermia, also known simply as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme ...

: body temperature not maintained *

Hydrogen Hydrogen is the chemical element with the symbol H and atomic number 1. Hydrogen is the lightest element. At standard conditions hydrogen is a gas of diatomic molecules having the formula . It is colorless, odorless, tasteless, non-toxic ...

ions ( Acidosis) *

Hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose be ...

: Low blood glucose levels ;'T's * Tension pneumothorax: increased pressure in the thoracic cavity, leading to decreased venous return to the heart * Tamponade: fluid or blood in the pericardium, compressing the

* Toxic and/or

therapeutic A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many differe ...

: chemicals, whether medication or poisoning * Thromboembolism and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a blood clot or other material) As of December 2005, advanced cardiac life support guidelines have changed significantly. A major new worldwide consensus has been sought based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30:2 for adults, to produce higher coronary and cerebral perfusion pressures. Defibrillation is now administered as a single shock, each followed immediately by two minutes of