ACLS Concise Algorithm Review

Initial treatment of symptomatic bradycardia

Atropine: First dose is 1mg bolus, then repeat every 3-5 mins PRN (max 3mg)

Second-line treatment of symptomatic bradycardia

Transcutaneous pacer

Alternative treatment of symptomatic bradycardia if atropine and transcutaneous pacing fail

Dopamine (5-20mcg/kg/min) or Epinephrine (2-10mcg/min) infusion

Initial treatment of regular SVT

Vagal maneuvers

Adenosine 6mg, 12mg, 12mg

Initial treatment of regular tachycardia with no wide QRS

Regular: Vagal maneuvers ± Adenosine (6mg IV push followed by NS flush)

Second-line treatment of regular tachycardia with no wide QRS

Beta-blockers

Calcium channel blockers

Initial treatment of SVT in unstable patient

Immediate synchronized cardioversion: Sedation and Adenosine (if immediately available)

Synchronized Cardioversion

• A. fib/A. flutter: 200J

• Narrow complex tachycardia/Monomorphic VT: 100J

Treatment of Asystole, Pulseless electrical activity

Immediately Epinephrine

• CPR than Epinephrine every 3-5 mins PRN

Treatment of polymorphic V-tach, unstable patient

Immediate defibrillation

(sedation)

Treatment of polymorphic V-tach, stable patient

Magnesium 1-2g

General algorithm for VFib or pulseless V-tach

ABCs

CPR

Cycles of [ Shock, CPR + drug for 2 min ]

Initial drugs to use in pulseless Vfib/Vtach

Epinephrine 1mg every 5 minutes

Amiodarone 300mg, 150mg

Second line drugs to use in pulseless Vfib/Vtach

Vasopressin 40U can be substituted for epi

After amio, try:

- Lidocaine 1.5mg/kg

Shock strength to use in pulseless Vfib/Vtach

120-200J biphasic

360J monophasic

What do the "H's & T's" cause?

Asystole, PEA

The "H's"

Hypoxia

Hypovolemia

Hypo/hyperglycemia

Hypothermia

Hydrogen ion (pH)

Hypo/hyperkalemia

The "T's"

Toxins

Tamponade (cardiac)

Tension pneumothorax

Thrombus (PE or AMI)

Trauma

General algorithm for asystole/PEA

ABCs

CPR

Epinephrine 1mg every 5 minutes

Treat underlying cause ("H's T's")

8 Ds of Stroke Care

Detection, Dispatch, Delivery, Door, Data, Decision, Drug, Disposition

Avoid Excessive ventilation why?

Increases intrathoracic pressure, Decreases venous return to heart, Diminshes cardiac output, may cause cerebral vasoconstriction

General Algo for Pregnancy Cardiac arrest

ABCs

CPR: put left lateral uterine displacement (fundal height at/above umbilicus)

Resuscitation in pregnancy: IV above diaphragm and stop IV mag

Resuscitative delivery: fundal height at/above umbilicus Hy

Hypotension mangement

IV Bolus: 1-2L NS/LR

Norepinephrine: 0.1-0.5mcg/kg per minute IV infusion (SBP >90 or MAP >65)

Epinephrine: 2-10mcg/kg per minute IV infusion (MAP >65)

Dopamine: 5-20mcg/kg per minute IV infusion (MAP >65)