Advanced Cardiovascular Life Support (ACLS) provides guidelines for managing life-threatening cardiovascular emergencies. These protocols build upon Basic Life Support (BLS) by incorporating advanced medical procedures and techniques. Pulse checks are a fundamental component of ACLS, assessing circulatory status during critical situations.
The Critical Role of Pulse Checks in ACLS
Pulse checks serve multiple purposes in patient assessment within the ACLS framework. They help confirm cardiac arrest, determine if effective circulation is occurring, and evaluate ongoing cardiopulmonary resuscitation (CPR) efforts. These assessments also help detect the return of spontaneous circulation (ROSC).
Minimizing interruptions to chest compressions is critical during resuscitation efforts, as brief pauses significantly reduce survival rates. When compressions pause, blood pressure drops, requiring several compressions to restore adequate circulation. Therefore, minimizing pulse check duration is important for maintaining consistent, high-quality CPR and ensuring vital organs receive sufficient blood flow.
Scheduled Checks During Cardiac Arrest Resuscitation
During cardiac arrest, pulse checks are performed at specific intervals to guide resuscitation efforts. Initially, a pulse check lasting no more than 5 to 10 seconds confirms cardiac arrest before initiating CPR. This brief assessment ensures prompt CPR if a pulse is absent.
Throughout ongoing CPR, pulse checks integrate with rhythm checks every 2 minutes. This 2-minute cycle allows assessment of the patient’s cardiac rhythm and resuscitation effectiveness while minimizing interruptions. Each pulse check should not exceed 10 seconds to maximize hands-on compression time.
Following interventions like defibrillation, chest compressions immediately resume for a full 2-minute cycle before another pulse check. This practice acknowledges that a palpable pulse may not return immediately after a successful shock. Epinephrine is generally administered every 3 to 5 minutes, often coinciding with these scheduled rhythm and pulse checks.
Identifying Return of Spontaneous Circulation (ROSC)
Return of spontaneous circulation (ROSC) signifies the re-establishment of a detectable pulse and blood pressure, indicating effective heart pumping. A palpable pulse is the most direct indicator. Quantitative waveform capnography is also a reliable method; a sudden, sustained increase in end-tidal carbon dioxide (ETCO2) to 35-45 mmHg suggests improved cardiac output and blood flow to the lungs.
Once ROSC is achieved, care transitions to post-cardiac arrest management. This phase involves immediate stabilization and ongoing monitoring to support organ function and improve patient outcomes. Key components include optimizing ventilation and oxygenation, maintaining stable blood pressure, and often initiating targeted temperature management to protect neurological function.