ACLS 2026: Cardiac Arrest & Epinephrine

Patient in cardiac arrest has no advance airway. What is compression to ventilation ratio?

30:2

Patient in cardiac arrest has an advanced airway. How often to give breath?

1 breath every 6 seconds, breath over 1 second

5 H's

Hypovolemia, Hypoxia, Hydrogen Ions (acidosis), Hypo K/Hyper K, Hypothermia

5 T's

Tension Pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary), Thrombosis (coronary)

Most common cause of PEA

hypoxia, hypovolemia

When to give epinephrine with patient in VF/pVT

between 2nd and 3rd defib

When to give epinephrine with patient in asystole/PEA

ASAP

Dose and frequency epinephrine in cardiac arrest

1mg IV/IO every 3-5 minutes

Medication considerations for patient in VF/pVT after THIRD defib

amiodarone or lidocaine

Cardiac arrest amiodarone dosing

first dose 300mg bolus IV/IO, second dose 150mg IV/IO

Cardiac arrest lidocaine 1st dose

1-1.5mg/kg IV/IO

Cardiac arrest lidocaine 2nd dose

0.5-0.75 mg/kg IV/IO at 5-10 minute intervals, max total dose 3mg/kg

adenosine 1st dose

6 mg IVP (rapidly) followed w/ 20cc NS flush

adenosine 2nd dose

1-2 minutes after 1st dose, 12 mg IVP (rapidly)

adenosine patient considerations

- may cause bronchospasm, bronchoconstriction in pts with copd, asthma.

- will not terminate afib/flutter

procainamide IV dose

20-50 mg/min

antiarrhythmic infusions for STABLE wide QRS tachycardia

procainamide, amiodarone

amiodarone 1st dose for life threatening arrhythmias

150mg over 10 minutes

amiodarone maintenance infusion for life threatening arrhythmias

1mg/min for first 6 hours

synchronized cardioversion charge for atrial fibrillation

200 J

synchronized cardioversion charge for atrial flutter

200 J

synchronized cardioversion charge for narrow complex tachycardia

100 J

synchronized cardioversion charge for monomorphic VT

100 J

defib. charge for polymorphic VT

"unsynchronized, high0energy shock"

treatment for symptomatic bradycardia with cardiopulmonary compromise

atropine

treatment for symptomatic bradycardia with cardiopulmonary compromise and ineffective atropine

TCP and/or dopamine infusion and/or epinephrine infusion

atropine dosage

1mg IVP every 3-5 minutes, max total dose 3mg

dopamine infusion dosage

5-20 mcg/kg/min

patient consideration before starting dopamine infusion

is there hypovolemia? if yes need to correct

epinephrine infusion dosage

2-10 mcg/min

TCP initial demand rate

60-80 (adjust with pt clinical response)

treatment for non-symptomatic bradycaria

*observe, support abcs, consider O2, obtain 12-lead

ROSC obtained, initial stabilization tasks

-manage airway (confirm placement)

-manage oxygenation and ventilation (SPO2 90

ROSC initial stabilization early diagnostic testing

12-lead, consider diagnostic imaging