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Comprehensive Advanced Life Support
Aka: Comprehensive Advanced Life Support, CALS, CALS Universal Approach
- See Also
- ABC Management
- Trauma Evaluation (ATLS)
- Pediatric Resuscitation
- Newborn Resuscitation
- Precautions
- These notes are NOT an official CALS program reference
- Goals of these notes was to ensure I was preparing adequately for course taken in 2017
- CALS study materials are expansive (3 volumes) and only loosely organized
- Outline below roughly covers similar material to CALS, but links are to my own colated notes from various sources
- Linked topics, despite being up-to-date, are likely to vary from CALS guidelines
- Sources include primary emergency medicine literature, as well as CALS, PALS, NRP, ALSO, ATLS
- Definition
- Comprehensive Advanced Life Support (CALS)
- Resuscitation course targeted at rural medical providers and combines aspects of ACLS, PALS, NRP, ALSO and ATLS
- Focus on emergency skills, knowledge and equipment, effective teams and patient focused care
- Protocol: Universal Approach
- General Approach
- Emergency Decision Cycle (OODA Loop, AAADA Model)
- Advanced Directives in the Emergency Department
- Step 1: Ready for patient arrival
- Activate team and assign roles
- Apply applicable protocols
- Review patient record in EMR if available
- Step 2: Patient arrival and situation control
- Everyone quiet while EMS gives report
- Restrain or immobilize patient as needed (e.g. Sedation in Excited Delirium)
- Step 3: Primary Survey (lead by Team Leader)
- ABC Management
- Includes Adult Resuscitation, Pediatric Resuscitation, Cardiac Arrest and CPR
- Includes Trauma Primary Survey (includes Exsanguination management)
- Emergency Airway Management
- Emergency Breathing Management
- Emergency Circulation Management
- Emergency Disability Management (AVPU, GCS)
- Emergency Exposure Management
- Initial Measures
- IV-O2-Monitor
- Vital Signs
- EKG
- Immediate interventions
- DONT Mnemonic (Dextrose, Oxygen, Naloxone, Thiamine) for Altered Level of Consciousness
- Consider Reversible Causes of Cardiopulmonary Arrest
- SAMPLE History (Signs/Symptoms, Allergies, Meds, PMH, Last Meal, Events)
- Obtained as able from EMS, family or patient
- Step 4: Secondary Survey and Focused Evaluations
- Trauma Secondary Survey
- See System Specific Protocols as described below
- Evaluate with serial exams, labs, imaging, diagnostics
- Step 5: Working Diagnosis, Stabilization and Disposition
- Return to Step 3 if patient decompensates or fails to improve
- Induced Therapeutic Hypothermia (e.g. Post-Cardiac Arrest Care)
- Emergency Transport (to higher level of care)
- See Transfer of the Critically Ill Patient
- Step 6: Team Process Review
- Debriefing as needed
- Protocol: Cohort Specific
- Pediatric specific management
- Pediatric Emergency Care
- Emergency Pediatric Dosing (Broselow Tape)
- Pediatric Assessment Triangle
- Newborn Resuscitation
- Newborn Distress
- Dehydration Management in Children
- Obstetric specific management
- Obstetric Emergency (Obstetrical Resuscitation)
- Obstetrical Trauma
- Placental Abruption
- Placenta Previa
- Postpartum Hemorrhage
- Shoulder Dystocia
- Assisted Delivery
- Cesarean Section
- Perimortem Cesarean Section
- Other patient specific guidelines
- Obesity and Emergency Stabilization
- Protocol: System Specific
- Cardiovascular Emergencies
- Ventricular Fibrillation or Pulseless Ventricular Tachycardia
- Asystole or Pulseless Electrical Activity (PEA)
- Unstable Bradycardia
- Unstable Tachycardia
- Atrial Fibrillation Acute Management
- Acute Coronary Syndrome
- Aortic Dissection
- Cardiac Tamponade
- Cardiogenic Shock (Acute Pulmonary Edema)
- Hypertensive Emergency
- Eye Emergencies
- Eye Trauma
- Blunt Eye Injury
- Central Retinal Artery Occlusion
- Chemical Eye Injury
- Globe Perforation
- Retrobulbar Hematoma
- Respiratory Emergencies
- Pulmonary Embolism
- Foreign Body Aspiration
- Tension Pneumothorax
- Pulmonary Contusion
- Status Asthmaticus
- Flail Chest (or multiple Rib Fractures)
- Hematologic and Oncologic Emergencies
- Oncologic Emergency
- Neutropenic Fever
- Anticoagulant Reversal
- Neurologic Emergencies
- Emergency Neurologic Exam
- Seizure Emergency Management (Status Epilepticus)
- Altered Level of Consciousness
- Closed Head Injury
- Brainstem Herniation
- Cerebrovascular Accident
- Penetrating Neck Trauma
- Psychiatric Emergencies
- Psychiatric Exam in the Emergency Department
- Excited Delirium
- Sedation in Excited Delirium
- Fluids, Electrolytes and Nutrition Emergencies (as well as renal emergencies)
- Hemorrhagic Shock
- Hemodialysis Emergency
- Metabolic Acidosis
- Infectious Emergencies
- Septic Shock
- Community Acquired Pneumonia
- Healthcare Associated Pneumonia (HCAP, Nosocomial Pneumonia)
- Meningitis
- Encephalitis
- Abdominal Emergencies
- Abdominal Aortic Aneurysm
- Orthopedic Injury
- Skeletal Immobilization (Cervical Collar, Spine Board, Four-Person Log Roll)
- Cervical Spine Injury
- Thoracolumbar Injury
- Pelvic Fracture
- Femur Fracture
- Trauma and Environmental Injuries
- Heat Related Illness
- Burn Injury
- Hypothermia Management
- Frostbite
- Unknown Ingestion
- Biological Weapon
- Chemical Weapon
- Mass Casualty Incident
- Blast Injury
- Gunshot Wound
- Knife Wound
- Protocol: Skills
- See Emergency Procedure Skills
- Airway
- Nasopharyngeal Airway and Oropharyngeal Airway
- Rapid Sequence Induction
- Advanced Airway
- Endotracheal Intubation
- Cricothyrotomy
- Breathing
- Chest Tube
- Needle Decompression of Thorax
- Non-Invasive Positive Pressure Ventilation (NIPPV, BiPap, CPap)
- Mechanical Ventilation
- Circulation
- Defibrillation
- Synchronized Cardioversion
- Emergency Transvenous Pacing
- Emergency Pericardiocentesis
- Emergency Thoracotomy
- Arterial Cannulation (Arterial Line)
- Central IV Access
- Umbilical Vein Catheter
- Intraosseous Access
- Disability
- Skull Trephination
- Trauma
- Hemorrhage Management
- Pelvic Binder
- Imaging
- Bedside Ultrasound
- FAST Exam
- Emergency Echocardiography
- Medications
- Procedural Sedation and Analgesia
- Sedation in Excited Delirium
- Miscellaneous
- Orogastric Tube
- Nasogastric Tube
- Suprapubic Catheterization
- Protocol: Safety
- Emergency Department Violence
- Emergency Exposure Management
- Protocol: Medications
- Procedural Sedation and Analgesia
- Sedation in Excited Delirium
- Protocol: Miscellaneous (not yet covered)
- Emergency Preparedness
- Universal Approach
- References
- (2016 ) CALS, 14th Ed