ACLS Protocols

What are the ACLS rhythm categories?

Slow, normal, fast, or dead

What should be done immediately for asystole and PEA?

Begin CPR

Adult CPR ratio for asystole and PEA

30:2 with rescue breathing

Compression strategy with advanced airway in asystole and PEA

Continuous compressions

Epinephrine dose for asystole and PEA

1 mg

Epinephrine concentration for asystole and PEA

1:10,000

Epinephrine frequency for asystole and PEA

Every 3–5 minutes for duration of code

When should an advanced airway be placed during cardiac arrest?

Anytime in the early stages of arrest as time and personnel allow

What should be considered throughout cardiac arrest?

H’s and T’s

Are asystole and PEA defibrillated?

No

What should be done immediately for pulseless VT and VF?

Begin CPR

Adult CPR ratio for pulseless VT and VF

30:2 with rescue breathing

Compression strategy with advanced airway in pulseless VT and VF

Continuous compressions

When should pulseless VT and VF be defibrillated?

Immediately when AED/monitor becomes available

LifePak defibrillation sequence

200 J, 300 J, 360 J

Zoll defibrillation energy

200 J

When should IV/IO access be established during pulseless VT and VF?

As soon as possible

Epinephrine dose for pulseless VT and VF

1 mg

Epinephrine concentration for pulseless VT and VF

1:10,000

Epinephrine frequency for pulseless VT and VF

Every 3–5 minutes for duration of code

When should an advanced airway be placed during pulseless VT and VF?

Anytime in the early stages of arrest as time and personnel allow

When is amiodarone given during VF/pVT arrest?

If VF/pVT persists during second round of CPR after epinephrine

Amiodarone dose for VF/pVT arrest

300 mg

Symptomatic bradycardia atropine single dose

1 mg

Symptomatic bradycardia atropine maximum cumulative dose

3 mg

Transcutaneous pacing starting current

25 mA+

Transcutaneous pacing rate

70–80 bpm

What indicates electrical capture during pacing?

Pacer spike immediately followed by wide QRS

What indicates mechanical capture during pacing?

Pulse correlating with pacing rate

Dopamine infusion for symptomatic bradycardia

5–20 mcg/kg/minute

Epinephrine infusion for symptomatic bradycardia

2–10 mcg/minute

Which heart blocks are considered high-degree heart blocks?

Second Degree Type II and Third Degree

Treatment for symptomatic high-degree heart block

Transcutaneous pacing

Dopamine infusion for high-degree heart block

5–20 mcg/kg/minute

Epinephrine infusion for high-degree heart block

2–10 mcg/minute

Stable SVT heart rate

150 bpm

Stable SVT symptoms

No complaints, lightheaded, dizzy, palpitations, feels like heart is racing

First treatment for stable SVT

Vagal maneuvers

Stable SVT vagal maneuver instruction

Have patient bear down

First adenosine dose for SVT

6 mg rapid IVP

Second adenosine dose for SVT

12 mg rapid IVP

Standard total adenosine dose for SVT

18 mg

Maximum adenosine dose for SVT

30 mg

What should follow adenosine administration?

10–20 mL normal saline flush

Adenosine half-life

10 seconds

Unstable SVT symptoms

Chest pain, difficulty breathing, decreased LOC, low BP, signs of inadequate perfusion

First synchronized cardioversion energy for unstable SVT

50–100 J

Second synchronized cardioversion energy for unstable SVT

200 J

Third synchronized cardioversion energy for unstable SVT

300 J

Fourth synchronized cardioversion energy for unstable SVT

360 J

Additional synchronized cardioversion energy for unstable SVT

360 J

What sedation may be considered for unstable SVT?

Valium or Versed

Stable A-Fib heart rate

150 bpm

Stable A-Fib symptoms

No complaints, lightheaded, dizzy, palpitations

What should be done for stable A-Fib unless already in protocols/orders?

Contact Medical Direction

Cardizem dose for stable A-Fib

0.25 mg/kg over 2 minutes

Repeat Cardizem dose for stable A-Fib

0.35 mg/kg in 15 minutes

Unstable A-Fib symptoms

Chest pain, difficulty breathing, decreased LOC, hemodynamically unstable

Biphasic synchronized cardioversion for unstable A-Fib

120–200 J

Monophasic synchronized cardioversion for unstable A-Fib

200 J

What sedation may be considered for unstable A-Fib?

Valium or Versed

Ventricular tachycardia with pulse heart rate

150 bpm

Stable VT symptoms

No complaints, lightheaded, dizzy, palpitations, feels like heart is racing

Amiodarone dose for stable VT

150 mg over minimum of 10 minutes

Procainamide dose for stable VT

25–50 mg/minute

Sotalol dose for stable VT

100 mg (1.5 mg/kg) over 5 minutes

Unstable VT symptoms

Chest pain, difficulty breathing, decreased LOC, hemodynamically unstable

First synchronized cardioversion energy for unstable VT

50–100 J

Second synchronized cardioversion energy for unstable VT

200 J

Third synchronized cardioversion energy for unstable VT

300 J

Fourth synchronized cardioversion energy for unstable VT

360 J

Additional synchronized cardioversion energy for unstable VT

360 J

What sedation may be considered for unstable VT?

Valium or Versed

Hypovolemia treatment

Fluid resuscitation

Hypoxia treatment

Oxygenation/ventilation

Hydrogen ion acidosis treatment

Sodium bicarbonate

Hyperkalemia treatment

Calcium

Hypoglycemia treatment

Dextrose IVP

Hypo/Hyperthermia treatment

Warm/Cool

Toxins treatment

Narcan (opiates)

Tamponade treatment

Pericardiocentesis

Tension pneumothorax treatment

Needle decompression

Thrombosis treatment

Fibrinolytics/Clot removal

Trauma treatment

Control bleeding

What are the H’s and T’s?

Finding and treating the potential causes of cardiac arrest