Initial Assessment in Advanced Cardiovascular Life Support (ACLS): A Comprehensive Overview

The initial assessment phase within the framework of Advanced Cardiovascular Life Support (ACLS) serves as the cornerstone upon which the entire ACLS algorithm rests, forming an indispensable foundation for efficiently and proficiently managing a diverse array of emergent medical scenarios. This pivotal stage of assessment is not merely a procedural formality but rather a critical juncture where healthcare providers must swiftly and accurately evaluate the patient’s condition, swiftly identifying and prioritizing interventions that are tailored to address the specific cardiac or respiratory emergency at hand. From identifying life-threatening arrhythmias to assessing the adequacy of oxygenation and circulation, the initial ACLS assessment encompasses a comprehensive evaluation of vital signs, symptoms, and potential underlying causes of the crisis. Furthermore, this assessment serves as a springboard for subsequent decision-making processes, guiding the selection of appropriate interventions and pharmacological therapies aimed at restoring perfusion, stabilizing cardiac rhythms, and ultimately optimizing patient outcomes. By recognizing the paramount importance of this initial assessment phase, healthcare providers can effectively lay the groundwork for the successful implementation of ACLS protocols, ensuring timely and targeted interventions for each patient needing resuscitation.
The initial assessment begins with the Basic Life Support (BLS) Assessment, which comprises four main steps:
  1. Check Responsiveness: Begin by tapping and shouting, “Are you all right?” while scanning the patient for absent or abnormal breathing, lasting approximately 5-10 seconds.
  2. Activate Emergency Response: Activate the emergency response system if the patient is unresponsive, activate the emergency response system and get an Automated External Defibrillator (AED). If there are multiple rescuers, designate one to activate the emergency response and retrieve the AED/Defibrillator.
  3. Circulation: Check for a carotid pulse within 5-10 seconds. If no pulse is palpable, initiate cardiopulmonary resuscitation (CPR).
  4. Defibrillation: If no pulse is detected, assess for a shockable rhythm using the AED or defibrillator upon its arrival.
  5. Turn on the AED as soon as it arrives on the scene and follow the instructions provided by the AED or initiate ACLS Protocol.
For a more detailed understanding of BLS, refer to the American Heart Association’s BLS Provider Manual. It is crucial to assess before taking appropriate actions and to reassess after each action.
The Primary Assessment in ACLS utilizes the ABCDE model to systematize the assessment process:
  • Airway: Ensure airway patency and use advanced airway devices if necessary. Confirm proper placement and secure the advanced airway.
  • Breathing: Administer bag-mask ventilation, provide supplemental oxygen, and monitor ventilation and oxygenation adequacy.
  • Circulation: Establish intravenous (IV) access if possible, if IV access not possible establish IO access, attach electrocardiogram (ECG) leads, identify and monitor arrhythmias, administer fluids if necessary, and administer defibrillation if shockable rhythm is present.
  • Disability: Conduct a neurological assessment, evaluating responsiveness, level of consciousness, and pupil reflex using the AVPU acronym (Alert, Voice, Painful, Unresponsive).
  • Exposure: Remove clothing for a comprehensive visual assessment, checking for trauma, bleeding, burns, or medical alert bracelets.
The Primary Assessment is integral to every ACLS algorithm, streamlining the resuscitation process and enhancing patient outcomes.
Additionally, the secondary assessment involves identifying underlying causes for the emergency and obtaining a focused medical history, often referred to as the differential diagnosis, encompassing the H’s and T’s of ACLS. For a detailed review of H’s and T’s, visit the respective page.
Performing a focused medical history can be simplified using the acronym SAMPLE:
  • S: Signs and symptoms
  • A: Allergies
  • M: Medications
  • P: Past Illnesses
  • L: Last Oral Intake
  • E: Events Leading Up To Present Illness
By following these structured assessment protocols, healthcare providers can systematically evaluate and manage emergency situations, ultimately improving patient outcomes in ACLS scenarios.

For more information on ACLS or to prepare for your upcoming ACLS course go to

American Heart Association. (2020). Basic Life Support (BLS) Provider Manual. Dallas, TX: American Heart Association.
American Heart Association. (2020). Advanced Cardiovascular Life Support (ACLS) Provider Manual. Dallas, TX: American Heart Association.

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