Jochen Lander

Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).

Key aspects of ALS level care include:

In cases of cardiac arrest, ALS builds on the foundations of basic life support (BLS) interventions such as bag-mask ventilation with high-flow oxygen, chest compressions, and use of an AED.

The core algorithm of ALS that is invoked when cardiac arrest has been confirmed, Advanced Cardiac Life Support (ACLS), relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation and/or medication may be administered. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effectiveness of the interventions on the heart rhythm, as well as the presence of cardiac output, is assessed.

Medications that may be administered include adrenaline (epinephrine), amiodarone, atropine, bicarbonate, calcium, potassium and magnesium, among others. Saline or colloids may be administered to increase the circulating volume.

While CPR is performed (which may involve either manual chest compressions or the use of automated equipment such as the AutoPulse or LUCAS device), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as "6Hs & 5Ts" according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS).[1][2][3][4] Note these reversible causes are usually taught and remembered as 4Hs and 4Ts[5]—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation.

As of December 2005, advanced cardiac life support guidelines have changed significantly. A major new worldwide consensus has been sought based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30:2 for adults, to produce higher coronary and cerebral perfusion pressures. Defibrillation is now administered as a single shock, each followed immediately by two minutes of CPR before rhythm is re-assessed (five cycles of CPR).

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).

Many healthcare providers are trained to administer some form of ALS.

In out-of-hospital settings, trained paramedics and some specifically trained emergency medical technicians typically provide this level of care. Canadian paramedics may be certified in either ALS (Advanced Care Paramedic-ACP) or in basic life support (Primary Care Paramedic-PCP). Some Primary Care Paramedics are also trained in intravenous cannulation, and are referred to as PCP-IV (see paramedics in Canada). Emergency medical technicians (EMTs) are often skilled in ALS, although they may employ a slightly modified version of the medical algorithm. In the United States, Paramedic level services are referred to as advanced life Support (ALS). Services staffed by basic EMTs are referred to as basic life support (BLS). Services staffed by advanced emergency medical technicians can be called limited advanced life support (LALS), Intermediate Life Support (ILS), or simply advanced life support (ALS), depending on the State. In the Republic of Ireland, advanced life support (ALS) is provided by an advanced paramedic. Advanced Paramedic (AP) is the highest clinical level (level 6) in pre-hospital care in the Republic of Ireland based on the standards set down by PHECC, the Irish regulatory body for pre-hospital care and ambulance services. This terminology extends beyond emergency cardiac care to describe all of the capabilities of the providers.

In hospitals, ALS is usually given by a team of doctors and nurses, with some clinical paramedics practicing in certain systems. Cardiac arrest teams, or "Code Teams" in the US, generally include doctors and senior nurses from various specialties such as emergency medicine, anesthetics, general or internal medicine.

NEW YORK -- Test results are in for the 2022 New York state grades 3-8 English Language Arts (ELA) and math exams.

This marks the first time in two years the majority of enrolled students took the tests due to the pandemic.

In 2020, there was no exam, and in 2021, only 21% of students took the New York state ELA and math exams since it was optional and given in-person only.

Because of this lack of data for those years, the Department of Education is comparing 2022 results with pre-pandemic 2019.

For math, grades 3-8 all saw a decrease. The percent proficient went down 7.6%.

For ELA, grades 3-5 saw a decline, but 6-8 had an increase. The DOE says this implies the students in grades 1-3 who were still learning to read during the pandemic struggled more.

They say these results are similar to the effect remote learning seems to have had nationally.

"She was in 3rd grade and in 2nd grade in the pandemic, so it was a little hard. Not the reading, but definitely the math," parent Linette Cabral said.

Cabral says when in-person learning picked back up, her 4th grader was behind in math, though she's improving now.

"It's really good at school. I'm trying my best at math," 4th grader Mila said.

"That's how you can see how, the difference that a teacher makes while they're in class," Cabral said.

The executive director of Advocates for Children of New York released the following statement:

Wednesday morning, schools chancellor David Banks wouldn't comment specifically on the results until they were made public Wednesday afternoon, but he had this to say about standardized testing: "Test scores are important, but they're not everything."

He was speaking at a Queens high school about Student Pathways, programs where students can learn about different careers, get paid internships and learn digital and financial literacy.

"I would dare tell you, the return on investment is not the scores they got on standardized exams. It's about their readiness to take their rightful place in the 21st century economy," Banks said.

The first deputy chancellor says the exam test results are complicated by the pandemic and also "reflect opportunity gaps and outcomes in particular for Black and Hispanic students as well as students with disabilities and English-language learners that are unacceptable."

The town was founded in 1843 and named for Lieutenant Henry William St Pierre Bunbury , who had explored the area By the mid-19th century, Bunbury was well

Chest binders —articles of clothing that gently compress breast tissue to reduce its appearanceare essential garments for those whose chest area

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