ACLS 2020 NOTES ONLY

1
1
START CPR Initial Assessment
• Give Oxygen • Assess for scene safety
• Apply monitor/defib pads • Assess for appearance, WOB, and circulation
• Check responsiveness

Yes No
Rhythm Shockable? Yes No
Unresponsive?
2 9
VF/pVT p. 134 Asystole/PEA p. 117 p. 18 p. 21
2 3

3 HQ-BLS
Defibrillate Give
PRIMARY ASSESSMENT
120-200 J biphasic Epinephrine Check for carotid pulses 5-10 seconds A – Airway
360 J monophasic ASAP Activate Code/EMS - Position, Suction, Insert OPA/NPA if needed
- Consider advanced airway
4 10 Start High-Quality CPR - Check placement of advanced airway
CPR 2 mins • RATE: at least 100-120/min B – Breathing
• IV/IO access
CPR 2 mins
• IV/IO access
• DEPTH: 2-2.4 inches, 5-6 cm, 1/3 A- - Assess for respiratory rate and effort
• Epinephrine 1 mg every 3-5 P diameter - Support breathing: give 1 breath every 6
mins • RECOIL: allow complete chest recoil sec. (10 breaths/min)
No • Consider advanced airway
Rhythm Shockable? C – Circulation
Basic CPR: 30:2 - Apply monitors, Obtain IV/IO access
5 Yes 30 compressions and give 2 breaths - Draw labs/glucose, give meds/fluids
Yes (5 cycles in 2 mins) - Keep SpO₂ 94-99%; if ACS keep SpO₂ >90%;
Defibrillate
120-200 J biphasic Rhythm Shockable?
360 J monophasic
if with ROSC keep SpO₂ 92-98%
Advanced CPR: continued chest - Keep PETCO₂ 35-45 mm Hg
No
compressions and give 1 breath - Keep PETCO₂ >10 mm Hg with CPR
6 11 every 6 seconds (10 breaths/min) - Keep SPB > 90 mm Hg
CPR 2 mins CPR 2 mins with or without advanced airway - Keep IABP >20 mm Hg with CPR
• Epinephrine 1 mg every 3-5 • Treat reversible causes
D – Disability
mins
• Consider advanced airway - Check neurological function
Yes
- Assess LOC, GCS, PERRLA, AVPU (Alert,
Rhythm Shockable? AED Voice, Pain, Unresponsive)
No Defibrillate as soon as possible E – Exposure
Rhythm Shockable? No - Remove clothing
P – Power On
- Assess for signs of trauma, bleeding, burns,
Yes Go to 5 or 7 A – Attach AED pads to bare chest
7 • If no ROSC, go to 10 or 11 unusual markings, medical alerts
• If ROSC, to Post-Cardiac Arrest Care
A – Analyze (clear patient to analyze)
Defibrillate
120-200 J biphasic • Consider appropriateness of continued S – Shock (clear patient to shock)
360 J monophasic
12 resuscitation Resume high quality CPR immediately p. 22-23
4
8
p. 153 SECONDARY ASSESSMENT
CPR 2 mins 1. Optimize Ventilation & Oxygenation
Give Amiodarone IV/IO • Manage Airway: early ETT placement S.A.M.P.L.E.
• 1st dose: 300 mg bolus • Manage Respiratory Parameters: Signs and symptoms, Allergies, Medications, Past medical
• 2nd dose: 150 mg bolus Start 10 breaths/min, SpO₂ 92-98%, PaCO₂ 35-45 mm Hg history, Last meal consumed, Events
Or Lidocaine IV/IO 2. Treat Hypotension
• 1st dose: 1-1.5 mg/kg bolus • Manage Hemodynamic Parameters:
• 2nd dose: 0.5-0.75 mg/kg SPB >90 mm Hg, MAP >65 mm Hg
H & Ts
• Treat reversible causes Hypovolemia, Hypoxia, Hydrogen Ion (acidosis),
Give 1-2 L NS/LR and vasopressors if needed
Hypo/Hyperkalemia, Hypothermia
3. If ALOC initiate TTM (Targeted Temp. Management)
Tension Pneumothorax, Tamponade (cardiac), Toxins,
Induce hypothermia 32-36֯C for at least 24 hours
Thrombosis (pulmonary), Thrombosis (coronary)

Based on ACLS AHA Guidelines 2020 By Don Frasco, RN 12-2020 Ed

 1 INITIAL ASSESSMENT
2 • Assess for scene safety 2
• Assess for appearance,
p. 69
WOB, and circulation
• Check responsiveness
3
Persistent PRIMARY ASSESSMENT 3 Persistent Tachycardia
Bradyarrhythmia A.B.C.D.E. causing:
p. 79 p. 83, 185
No • Hypotension Yes
causing: SECONDARY • Acutely altered LOC
• Hypotension ASSESSMENT • Signs of shock
4
6
• Acutely altered LOC S.A.M.P.L.E. Wide QRS? • Ischemic chest discomfort
Premedicate
4 • Signs of shock ≥0.12 secs.
• Acute heart failure
whenever possible
No Yes
Monitor • Ischemic chest discomfort Yes No
and observe • Acute heart failure 7
5
Synchronized Cardioversion
Consider Adenosine
1st Degree AV block 5 (if monomorphic and
Atropine 1 mg IV regular) SYNC 50 – 100 J
bolus every 3-5 mins
(maximun of 3 mg) Narrow-Regular: SVT
Amiodarone 150 mg IV
If atropine is ineffective over 10 mins. followed
by 1 mg/min for the first 6
TCP
hours
• Apply pacing pads
PR Interval: FIXED, No blocked QRS • Turn pacer on
Procainamide 20-50
• Set on Demand mode
• Rate at 60-80/min
mg/min until arrhythmia
is suppressed,
2nd Degree AV block, Type I • Set output 2 mV and SYNC 120 - 200 J
hypotension ensues, QRS
increase until capture
duration increases >50%,
Narrow-Irregular: Afib
or maximum dose 17
and/or mg/min given.

Dopamine 5-20 Maintenance dose: 1-4

mcg/kg per min mg/min. Avoid prolonged
Titrate to patient response. QT or CHF.
PR Interval: VARIABLE, R-R Interval Irregular
Taper slowly
or
nd Epinephrine 2-10 mcg 8 SYNC 100 J
2 Degree AV block, Type II
per min. Vagal maneuvers
Titrate to patient response Wide-Regular: Monomorphic VT
(if regular)

Adenosine IV
6 (if regular)
1st dose: 6 mg RIVP
Consider:
PR Interval: FIXED, No Atropine, TCP 2ND dose: 12 mg RIVP
• Expert consultation
• Transvenous pacing Sotalol IV
3rd Degree AV block 100 mg (1.5 mg/kg) over
UNSYNC 120 - 200 J
5 mins. Avoid if prolonged
QT Wide-Irregular: Polymorphic VT (TdP)
Or
• Calcium-channel blocker
• Consider expert
consultation

PR Interval: VARIABLE, R-R Interval Regular, No Atropine, TCP

Only

Based on ACLS AHA Guidelines 2020 By Don Frasco, RN 12-2020 Edition