ADULT CARDIAC ARREST

ALS - 2020 VERSION

Shock Defibrillation Energy Doses
• Start CPR
Biphasic: Per manufacturer’s
Epinephrine
• Attach monitor/defibrillator recommendations (e.g., 120 to 200 J) or
if unknown, max available; subsequent
doses equal to or greater than first dose
Monophasic: 360 J for all doses

Shockable Medications
YES NO
rhythm?
Epinephrine
• 1 mg IV/IO bolus every 3 to 5 min
VF/pVT Asystole/PEA
Amiodarone
• First dose: 300 mg IV/IO bolus
Epinephrine ASAP
• Second dose: 150 mg after 3 to 5 min
C
• 2 min CPR • 2 min CPR Lidocaine
• IV/IO access • IV/IO access • First dose: 1 to 1.5 mg/kg IV/IO
• Subsequent doses: 0.5 to 0.75 mg/
• Administer epinephrine every kg IV/IO every 5 to 10 min, up to a
3 to 5 min max dose of 3 mg/kg
• Consider advanced airway,
High-Quality CPR
Shockable capnography
NO
rhythm? • Compress at a rate of 100 to 120
compressions per min and a depth of
YES at least 2 inches (5 cm); allow for full
chest recoil
Shockable • Minimize interruptions to chest
YES
A rhythm? compressions to less than 10 sec
• 2 min CPR • Avoid excessive ventilations. Each
• Administer epinephrine NO ventilation should last about 1 sec
and make the chest begin to rise
every 3 to 5 min
• Without advanced airway: 30
• Consider advanced compressions: 2 ventilations
airway, capnography YES ROSC? With advanced airway: continuous
compressions; deliver 1 ventilation
every 6 sec without pausing
NO compressions
Shockable
NO D • Rotate compressor every 2 min
rhythm?
• 2 min CPR • Monitor CPR quality with ETCO2 or
YES • Treat reversible causes arterial blood pressure (if available)
(Hs and Ts)
What Is ROSC?
• Pulse and blood pressure
B
• 2 min CPR • Sudden and sustained increase in
Shockable YES ETCO2
• Administer amiodarone OR rhythm?
lidocaine • Arterial pulse waveform on an a-line
when no compressions are being
• Treat reversible causes NO delivered
(Hs and Ts)
• Additional signs, including patient
movement, normal breathing or
YES ROSC? coughing, may be present

ROSC? Hs and Ts
NO • Hypovolemia
NO YES • Hypoxemia
• Hydrogen ion excess (acidosis)
Follow Adult Post–Cardiac • Hyperkalemia/hypokalemia
Go to C or D Go to C or D Go to A or B • Hypothermia
Arrest Care code card
• Hyperglycemia/hypoglycemia
• Tamponade (cardiac)
• Tension pneumothorax
• Thrombosis (pulmonary embolism)
• Thrombosis (myocardial infarction)
• Toxins

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