ACLS Flashcards
Cardiac Arrest Algorithm
VF/VT
- Shout for Help/Activate Emergency Response
- Start CPR - give O2 and Attach Monitor/Difib
- After 2 minutes check Rhythm. Shock if VF/VT.
- If return of Spontaneous Circulation go to Post-Cardiac Arrest Algorithm. If not resume CPR 2mins, IV/IO access, epi q3-5 minutes, Amiaodarone for refractory VF/VT. Consider Advanced Airway with capnography. Treat H&T’s
Cardiac Arrest Algorithm
Asystole/PEA
- Shout for Help/Activate Emergency Response
- Start CPR - give O2 and Attach Monitor/Difib
- After 2 minutes check Rhythm.
- If return of Spontaneous Circulation go to Post-Cardiac Arrest Algorithm. If not resume CPR 2mins, IV/IO access, epi q3-5 minutes, Consider Advanced Airway with capnography. Treat H&T’s
Return of Spontaneous Circulation Algorithm
ROSC
- Optimize ventilation and oxygenation
- Maintain Sat >94%
- Consider advanced airway with capnography
- Do NOT hyperventilate - Treat hypertension
-Iv/IO bolus
- administer vasopressor
- H&T’s
- 12 lead EKG - Does pt follow commands
-YES - Is it a STEMI OR AMI -
Yes - Coronary Reperfusion,
NO - Advanced Critical Care
-NO - Consider induced hypothermia - STEMI or AMI?
Yes - Coronary Reperfusion
No - Advanced Critical Care
Reversible Causes
H&T’s
- Hypo volemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hypo/Hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
Ventilation/Oxygenation Dose
Avoid excessive ventilation, start at 10-12 breath/min and titrate to target PETCO2 of 35-40mmHg. Titrate FIO2 to achieve SPO2 of >= to 94%
IV bolus dose
ROSC: 1-2 L of NS or LR if inducing hypothermia may use 4degree C fluid.
Epinephrine IV infusion Dose
ROSC: 0.1-0.5 mcg/kg per minute
(in 70kg adult: 7 -35mcg/min)
Bradycardia with a pulse: 2-10 mcg per minute
Dopamine IV infusion dose
ROSC: 5-10 mcg/kg per minute
Bradycardia with a pulse: 2-10 mcg/kg per minute
Norepinephrine IV infusion dose
ROSC: 0.1-0.5 mcg/kg per minute
in 70kg adult: 7 -35mcg/min
Shock Energy
Biphasic: Manufacturer recommendation; if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses may be considered.
- Monophasic: 360J
Epinephrine IV/IO dose
1 mg q3-5 minutes
Vasopression IV/IO dose
40 units can replace first or second dose of epinephrine
Amiodarone IV/IO dose
First dose: 300 mg bolus
Second dose: 150 mg bolus
Advanced Airway
- Supraglottic or ET intubation
- Waveform capnography to confirm and monitor ET tube placement
- 8 -10 BPM with continuous compression
Bradycardia with a pulse algorithm
- Assess for appropriateness for clinical condition. Is thier HR typically this low? Athlete?
- ID and treat underlying causes (patent airway, oxygen if hypoxemic, cardiac monitor to ID rhythm, monitor BP, IV access, EKG.
- Is bradycardia causing: hypotension, AMS, Shock, Chest discomfort, heart failure
No: Monitor and Observe
Yes: Atropine. If ineffective transcutaneous pacing, OR dopamine infusion OR epinephrine infusion
Atropine IV dose
First dose: 0.5mg bolus
repeat q3-5 minutes
Maximum of 3mg
Tachycardia with a pulse algorithm
-Assess for appropriateness of rhythm.
-ID and treat underlying cause (maintain airway, oxygen if hypoxemic, cardiac monitor to ID rhythm, monitor BP and O2)
- Persistent tachy causing: Hypotension, AMS, Shock, Chest discomfort, Heart failure?
-NO: is there a wide QRS >12 sec
NO: IV, EKG, Vagal manuvers, Adenosine
(if regular), Beta or calcium channel blocker,
consider expert consultation
-YES: Synchronized cardioversion: consider
sedation, if narrow complex consider adenosine.
Synchronized Cardioversion
Initial Doses
Narrow regular: 50-100J
Narrow irregular 120-200 biphasic or 200j monophasic
Wide regular: 100J
Wide irregular: defibrillation dose (NOT synchronized)
Adenosine IV dose
First dose: 6mg rapid IVP; follow with NS flush
Second dose: 12mg if required
Procainamide IV dose
Antiarrhythmic infusions for stable wide-QRS Tachycardia
20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50% or maximum dose 17mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
Amiodarone IV dose
Antiarrhythmic infusions for stable wide-QRS Tachycardia
First Dose: 150mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours.
Sotalol IV Dose
Antiarrhythmic infusions for stable wide-QRS Tachycardia
100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT
Acute Coronary Syndrome Algorithm
(Beginning Basics
Symptoms suggestive of ischemia or infarction
- EMS assessment and care and hospital preparation (Monitor, support ABCs, Be prepared to start CPR or defibrillation, MONA, mobilize resources of possible STEMI.
- Concurent ED assessment (
Acute Coronary Syndrom Algorithm for ST elevation or new or presumably new LBBB; strongly suspicious for injury.
ST-elevation MI (STEMI)
- Start adjunctive therapies as indicated.
- Do not delay reperfusion
How long ago did symptoms start?
- >12 hours
-Troponin elevated or high risk pt: start
adjunctive treatments as indicated: Nitro,
heparin, consider PO B-Blocker, Clopindogrel,
Glycoprotein IIb/IIIa inhibitor.
- Admit to monitor bed. Assess risk status,
continue ASA, heparin and other therapies as
indicated (ACE, ARB, statin therapy. Not high
risk cardiology to risk stratify
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