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
-
Acute Coronary Syndrome Algorithm for ST depression or dynamic T-wave inversion; strongly suspicious for ischemia.
High risk unstable angina/ non-ST elevation MI (UA/NSTEMI)
- 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
Acute Coronary Syndrome Algorithm for Normal or nondiagnostic changes in ST segment or T-wave.
Low/intermediate risk ACS.
- Considert admission to ED chest pain unit or appropriate bed and follow: serial cardiac markers, repeat ECG/continuous St-segment monitoring, consider noninvasive diagnostic tests.
- Develops 1 or more: Critial high risk features, Dynamic ECG changes consistent with ischemia, Troponin elevated.
- YES - go to high risk unstable angina/ NSTEMI
algorithm.
- NO - Abnormal diagnostic noninvasive imaging or
physiologic testing?
YES- Admit to monitored bed Assess risk
status continue ASA, heparin, and
other therapies as indicated.
NO - If no evidence of ischemia or infarction
by testing, can discharge with follow-up
