ACLS Algorithms & Notes

CPR Algorithm (CAB) • CAB= compressions, airway,

breathing- increased survival
Unresponsive & No Breathing rate with early compressions
↓ & early defib, body still has
Activate EMS/Code Blue oxygenated blood when
Get AED/Defibrillator person collapses pulse-less &
↓ goal is to get that circulating
Check Pulse (10 Sec.)-> Present=1 breath/5 sec & prime the pump (heart)
No Pulse • 2 minutes of high quality
↓
CPR & reassess & switch
Begin 30 Compressions & 2 Breaths
compressors
↓
• No longer look, listen and
AED/Defib arrives/Check Rhythm
feel for breathing
↓
• Compressions harder, faster,
Shockable Non Shockable
deeper 30 in 18 sec
↓ ↓
Give 1 Shock CPR for 2 min. • Rate of at least 100/min
Resume CPR Check Rhythm • Compression depth= 2 inches
• Allow complete chest recoil
after each compression
• Minimize interruptions in
CPR- < 10 sec & avoid over
ventilation
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Cardiac Arrest- Shockable Algorithm BLS Survey=
• Check responsiveness &
Start continuous CPR, call EMS/code, Apply O2, breathing
Attach monitor/defibrillator • Activate
↓ EMS/Code/AED/defib
Monitor shows V. Fib/V. Tach(no pulse) • Check Pulse no longer than
↓ 10 sec
Shock @ 200 Joules
• Defib/shock if needed
↓
ACLS Survey=
Resume CPR 2 min, Start IV/IO
• Progression of a BLS
↓
unconscious pt OR a
Epinephrine 1 mg IV every 3-5 minutes & Airway
conscious ACS (chest pain
with capnography
pt)
↓
Shock 200 J. & resume CPR 2 min • Airway- patent with O2 or
↓ more advanced with
Amiodarone 300 mg rapid IV push or 10 min drip capnography
↓ • Breathing- Ambu/ET tube= 1
Shock 200 J & CPR 2 min breath every 6-8 sec.
• Continual uninterrupted CPR & early • Circulation= EKG, IV/IO,
defib=increased chance survival medication given peripherally
• Safe defib= no O2 blowing on chest • Diagnosis- 5 H’s & 5 T’s
during shock. Hands free pads=more
rapid defib
 • PEA= no pulse= CPR
Cardiac Arrest- Non Shockable • PEA best described as Sinus
Algorithm (PEA/Asystole) Rhythm without pulse
Start continuous CPR, call EMS/code, Apply • Asytsole for awhile=
O2, Attach monitor/defibrillator consider terminating efforts
↓ • Start with basics first
Monitor Shows Asystole or PEA (ABC’s)
↓ • Unconscious pt with rhythm
CPR, IV/IO on monitor- first priority is
↓ determine if there is a pulse
Epinephrine 1 mg IV every 3-5 min. & Airway • Purpose of Rapid Response
with Capnography Team is to identify & treat
↓ early clinical deterioration
Treat Causes • Pt with epigastric pain=
STAT EKG rule out MI
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Capnography (PETCo2)
• Device placed between ET tube and ambu and hooked to monitor
• Measures amount Co2 exhaled by pt-waveform will increase when pt exhales
• Measure effectiveness if chest compressions
• Measures adequate coronary perfusion
• Best indicator of ET tube placement
• ROSC(return of spontaneous circulation)- target Co2 level is 35-40
• During ET suctioning withdraw no longer than 10 sec
• Avoid anchoring ET tube with ties around neck- if too tight can obstruct venous
return to brain
Return of Spontaneous Circulation (ROSC)
• Pt gets therapeutic hypothermia protocol which lowers their body temp
in order to help reduce the risk of ischemic injury to tissue & brain
following a period of insufficient blood flow
• Goal-
i. Cool for 24 hours to goal temp of 89-93 F
• Contraindication
i. pt responding to verbal commands
ii. Known pregnancy
iii. DNR
iv. Recent head trauma or traumatic arrest
v. In coma from other causes like; overdose, stroke, etc
vi. Temp already less than 93.2 F
• Indications:
i. Unresponsive pt not responding to commands after ROSC
ii. Estimated time from arrest to ROSC is less than 60 minutes
• If hypotensive with ROSC= 1-2 liters of NS or LR to keep minimum
systolic pressure of 90
• 1st priority in ROSC pt is to optimize ventilation and oxygenation
 Bradycardia Algorithm Treatable Causes
Hypoxia= Apply O2 and assure patent airway
Assess Clinical Condition: HR <50, B/P, Skin Hypovolemia= Give fluid bolus of N/S or LR
color, LOC, Pain, Dizziness, consider blood
↓ Hydrogen Ion= correct acidosis, advanced airway,
Identify Treatable Causes: Apply O2, Cardiac Capnography
Monitor, IV, EKG Hypothermia= Keep patient warm, while in arrest
↓ Hypo/hyper Kalemia= check potassium & correct
Symptomatic
↓
Atropine 0.5mg repeat every 5 min. to max of 3 Toxins= overdose of what?
mg Tension Pneumothorax= needle decompression &
↓ chest tube
If Atropine ineffective→ Pacing Tamponade(cardiac)= pericardiocentesis- remove
→ Dopamine Infusion 2- blood from heart sac
10 mcg/kg/min Thrombosis (pulmonary) = PE
→Epinephrine Infusion 2- Thrombosis (cardiac) = MI
10 mcg/min

Tachycardia With Pulse Algorithm • Non symptomatic stable SVT

do EKG 1st before meds
Assess clinical condition- HR >150, LOC, color, • Defib=Dead=200 J->V fib &
Pain, dizzy, B/P, Symptomatic or non Vtach- no pulse
↓ • Synch Cardioversion=
Identify Treatable Causes: Apply O2, Cardiac Crashing- SVT Vach with
Monitor, IV, EKG pulse
↓
Narrow Stable (SVT) Wide Stable (VT)
↓ ↓
Vagal maneuvers Amiodarone 150 mg
Adenosine 6 mg over 10 min.
Adenosine 12 mg Can consider Adenosine
if wide monomorphic

↓
Narrow Unstable (SVT) Wide Unstable
↓ ↓
Regular= 50-100 J Synch Synch 100 J
Cardioversion
Irregular= 120-200J Synch
 ACLS Medications Overview
Epinephrine (1:10,000)- (drug class= Vasopressor)
1 mg Rapid IV/IO push
1st for all pulseless arrests
Vasopressin (drug class= Vasopressor)
40 Units IV/IO- can replace 1st or 2nd Epi
Amiodarone
Used with ventricular rhythms (V-Fib / V-Tach)
Pulseless= 300 mg IV push or drip over 10 min
With pulse= 150 mg in 100 ml D5W drip over 10 min
Amiodarone Maintenance Drip= 450mg in 250 glass bottle of D5w Drip infusion
@ 1mg/min
Atropine
“A” for accelerate
0.5mg IV/IO—for sinus bradycardia may repeat every 5 minutes for Max of 3 mg

Adenosine
Used for SVT or stable monomorphic VT
6mg rapidly—may repeat with a 12mg x 2- always follow with NS bolus & give
closest to heart
Warn patient and family about drug related symptoms:
Chest pressure, feeling faint, EKG pause
Dopamine Drip
Chronotropic drug- given for Symptomatic Bradycardia refractory to Atropine
2-10 mcg/kg/min
Epinephrine Drip
2-10 mcg/min
For symptomatic bradycardia refractory to Atropine