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ACLS Megacode Algorithm

The document outlines guidelines for managing various cardiac arrhythmias during ACLS megacode testing. It discusses the roles and responsibilities of the team leader and performing high-quality CPR. Bradycardia, tachycardia, ventricular fibrillation, pulseless ventricular tachycardia, PEA, and asystole are each addressed with steps for recognition, treatment, and management, including appropriate drug administration and defibrillation when indicated. Post-cardiac arrest care procedures are also summarized.

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Peter Lee
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147 views

ACLS Megacode Algorithm

The document outlines guidelines for managing various cardiac arrhythmias during ACLS megacode testing. It discusses the roles and responsibilities of the team leader and performing high-quality CPR. Bradycardia, tachycardia, ventricular fibrillation, pulseless ventricular tachycardia, PEA, and asystole are each addressed with steps for recognition, treatment, and management, including appropriate drug administration and defibrillation when indicated. Post-cardiac arrest care procedures are also summarized.

Uploaded by

Peter Lee
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ACLS Megacode testing

- Team leader duties


(i) assign team member roles
(ii) ensure HQ CPR
- compression rate 100-120/min
- compression depth >= 5cm
- CCF >= 80%
(iii) ensure team member communicate well

- Bradycardia Mx
(i) recognize bradycardia
(ii) connect (instruct to connect) monitor, set up IV, ensure O2 access
(iii) ensure monitors placed in correct position
(iv) initiate mx (if stable, observe; if unstable, atropine)
1mg bolus, repeat every 3-5 mins, max 3mg
(v) prepare for 2nd mx
- consider possible hypoxic and toxicologic causes
- transcutaneous pacing
- dopamine infusion (usual rate: 5-20 mcg/kg/min)
- adrenaline (2-10 mcg/min)
if pacing doesn’t work, jz try dopamine/adrenaline

- Tachycardia Mx
(i) recognize tachycardia (pattern, pulse rate)
(ii) connect monitor, set up IV access, monitor O2 (and give O2 if
dyspnea/palpitations)
(iii) ensure that the monitor is correctly placed
(iv) recognize any sx due to unstable tachy/no sx due to stable tachy
(v) initiate tx (unstable  synchronized DCCV
stable and narrow complex  vagal maneuver/carotid massage/beta-blocker/CCB
stable and wide complex  adenosine (regular and monomorphic)
first give 6mg bolus flush with NS; then give 12mg as second time
otherwise/if refractory, give amiodarone (150 mg over 10 mins, then followed by
1mg/min over the next 6 hrs)
consider increase dosage of cardioversion (unstable)
underlying causes
expert consultation
- VF Management
(i) recognize VF
(ii) clear, charge the defibrillator, and then shock the patient with clearance
(iii) resume CPR immediately after shock
(iv) ensure airway management
(v) drug-rhythm cycle
(vi) appropriate drug administration
(recognition, clear + charge + shock, resume CPR, airway mx (after multiple bagging,
intubation), drug-rhythm cycle, appropriate drugs)

- pVT management
same as VF
(recognize VF, start CPR, clear + charge + shock, resume CPR immediately, adequate
airway management (tubing after bagging), drug-rhythm cycle, appropriate drug and
dosage)

- PEA/asystole
(i) recognize PEA/asystole
(ii) assess for the 5H and 5T reversible causes
(Hypothermia, Hypoxia, Hypovolemia, Hypo/HyperK, Acidosis/Tension
pneumothorax, cardiac tamponade, toxin (check pupil size), pulmonary/cardiac
embolism)
(iii) administer correct drug/dosage
(iv) resume CPR after rhythm check in 10 mins
(recognition, 5H5T, appropriate drug/dosage, resume CPR)

- Post-cardiac arrest care


(i) identify ROSC
(ii) verbalize connection of O2 monitoring, 12-lead ECG, when have pulse check BP,
+/- ETT/waveform capnography, investigations (as indicated)
(iii) TTM (32-36 degrees Celsius)

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