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Advanced Life Support (ALS, also reanimation) is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems, as agreed in Europe by the European Resuscitation Council, most recently in 2005. It is practiced by in-hospital cardiac arrest teams, which generally consist of junior doctors from various specialties (anesthetics, general or internal medicine). Emergency medical technicians (EMTs) are often skilled in ALS, although they may employ slightly modified version of the algorithm.In the US, an EMT capable of performing advanced life support is either an EMT-Intermediate or an EMT-Paramedic, commonly referred to simply as a paramedic. Canadian paramedics may be certified in either ALS or in only basic life support.In the United States, Intermediate and Paramedic level services are referred to as Advanced Life Support. Services staffed by basic EMTs are referred to as Basic Life Support. This terminology extends beyond emergency cardiac care to describe all capabilities of the providers. Under this use of the term, ALS more generally refers to services capable of procedures considered "advanced" such as cardiac monitoring, endotracheal intubation, intravenous therapy, and select trauma surgical procedures.The treatment algorithms that comprise ALS were agreed by the European Resuscitation Council to improve the outcomes of cardiac arrest.
Main algorithm ALS presumes that basic life support (bag-mask administration of oxygen and chest compressions) are administered.The main algorithm of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation is applied, and medication is administered. Oxygen 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, potassium and magnesium. Saline or colloids may be administered to increase the circulating volume.While CPR is given (either manually, or through automated equipment such as AutoPulse), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as "4H4T":
Other conditions ALS also covers various conditions related to cardiac arrest, such as cardiac arrhythmias (atrial fibrillation, ventricular tachycardia), poisoning and effectively all conditions that may lead to cardiac arrest if untreated, apart from the truly surgical emergencies (which are covered by Advanced Trauma Life Support).
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