The 4 Triads of ACLS Survey

Watch the video

The 4 Triads of ACLS Survey

The following 4 triads of ACLS survey is a structured approach aimed at rapid and prioritized patient assessment and intervention during emergencies.

1. A, B, C.
2. O2, I-V, monitors.
3. Blood pressure, pulse rate, and respiratory rate. 
4. History, physical, and labs.

1. A, B, C
A: assess airway:

• Establish and maintain a clear airway.
• Use the least invasive method necessary, such as a nasopharyngeal airway or a supraglottic airway device.

B: assess breathing:

• Assess breathing patterns and oxygenation levels. 
• Check SpO2.
• Check End-tidal CO2 level to verify endotracheal tube position.
• Avoid over-ventilation during manual bag-valve-mask ventilation.

C: assess circulation:

• Check pulse, blood pressure, capillary refilling time, and skin color.

D: defibrillate if indicated:

• If the patient is pulseless, immediate defibrillate if VF or VT is found on the ECG monitor.
• A traditional defibrillator or an AED can be used for this purpose.

2. O2, I-V, monitors

• Give oxygen via cannula or mask to maintain SpO2 at 94% or above.
• Establish I-V or I-O access.
• Obtain blood tests.
• Match blood type if indicated.
• Give fluids or medications.
• Give blood products if indicated.
• On monitors, include defibrillator, pulse oximeter, BP monitor, and waveform capnography.

3. Vital Signs

• Check blood pressure, pulse rate, and respiratory rate regularly
• Check additional vital signs if necessary, include body temperature, SpO2, fingerstick sugar, and GCS.
• Remember to re-evaluate ABC if vital signs suddenly deteriorate.

4. Differential diagnosis

• AMPLE is a mnemonic used to guide focused history-taking.
• A = Allergies.
• M = Medications.
• P = Past medical history.
• L = Last meal.
• E = Events leading up to the present situation.
• Physical examination and laboratory tests are also crucial for accurate differential diagnosis.

Conclusion

• The ACLS survey is a systematic and structured approach crucial in managing medical emergencies.
• By adhering to this 4-step approach, healthcare providers can provide swift intervention, significantly enhancing the chances of positive patient outcomes in critical situations.