ACLS Algorithm

Bradycardia

100

Heart rate to be considered a bradyarrhythmia?

Heart rate typically <50/min if bradyarrhythmia.

200

Identify and treat the underlying condition. What are the steps?

• Maintain patent airway; assist breathing as necessary

• Oxygen (if hypoxemic)

• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry

• IV access

• 12-Lead ECG if available; don’t delay therapy

• Consider possible hypoxic and toxicologic causes

300

If patient has CHAP what next? If ineffective what next?

Atropine

If atropine ineffective:

• Transcutaneous pacing and/or

• Dopamine infusion or

• Epinephrine infusion

400

Explain proper Transcutaneous Pacing of the patient. 

1. Consider premedication with Midazolam for pain control.
2. Apply pads: *Avoid placing the pads over an AICD or transdermal drug patches.*
3. Turn on the monitor and set it to "pacing mode".
4. Set the pacing rate to between 60–80 bpm.
5. Turn up the milliamps until the heart muscle is captured.
6. Check pulse or with ultrasound to confirm mechanical and electrical capture.
7. Set the final current 5–10 mA above the threshold level for the patient. Adjust the rate based on the patient's clinical changes. 

500

What can cause the bradyarrhythmia?

Myocardial ischemia/infarction, Drugs/toxicologic (eg, calcium-channel blockers, beta blockers, digoxin), Hypoxia, Electrolyte abnormality (eg, hyperkalemia) 

Tachycardia

100

Heart rate to be considered tachycardia? 

Heart rate typically ≥150/min if tachyarrhythmia.

200

If the patient has CHAP what is next stept? Narrow complex tachycardia what is the next step? 

Synchronized cardioversion, Consider sedation

If regular narrow complex consider adenosine 

300

If patient has wide-QRS complex, what is the next step?

Consider: Adenosine only if regular and monomorphic, Antiarrhythmic infusion, Expert consultation

400

If no CHAP what is next step?

Vagal maneuvers (if regular), Adenosine (if regular), β-Blocker or calcium channel blocker, Consider expert consultation

500

What is the the important step for SYNCRONIZED Cardioversion? What joules do you synchonize at?

Activate synchronized mode. 

100-120, 200, 300, 360 Joules.

Cardiac Arrest

100

Compression rate for adults? Depth? Change EMS doing compressions every ____?

100-120, 30:2

2- 2.4 inches: 5 cm

2 mintues

200

What should you do at 1:45 mark of CPR? 

Charge monitor for defibrilation. 

300

When administering defibrilation, how many Joules for Biphasic? Monophasic?

Biphasic: 100-120, 200, 300, 360

Monophasic: 360

400

If patient is in Asystole/PEA, what are the steps in the procedure? Pusle check every ____?

Check for Pulse, CPR 2 min, apply PADS, IV/IO access, Epinephrine every 3-5 min, Consider advanced airway, capnography

2 minutes

500

What are the 5 components of high quality CPR? 

(In the Southwest Protocol)

Ensuring chest compressions of adequate rate

Ensuring chest compressions of adequate depth

Allowing full chest recoil between compressions

Minimizing interruptions in chest compressions

Avoiding excessive ventilation

Post-Arrest

100

What does ROSC stand for? How to we determine ROSC?

Return of Spontaneous Circulation

Capnography, breathing, coughing, movement, a palpable pulse, and measurable blood pressure

200

Managing airway parameters: Breaths per minute? SPO2? PaCO2?

Start 10-12 breaths/min

Spo2 92%-98%

Paco2 35-45 mm Hg

300

Manage Hemodynamic Parameters: Blood pressure systolic? Mean Arterial Pressure (MAP)?

Systolic blood pressure >90 mm Hg 

Mean arterial pressure >65 mm Hg

400

Consider for emergent cardiac intervention if: ____, ____, ____.

STEMI present, Unstable cardiogenic shock, if Mechanical circulatory support is required

500

What are the H's and T's?

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/hyperkalemia, Hypothermia

Tension pneumothorax, Tamponade Cardiac, Toxins, Thrombosis Pulmonary, Thrombosis Coronary

Drug Administration

100

Epinephrine: Adults and Pediatrics?

1 mg (0.1mg/1mL) IV/IO every 3-5 min with no max.

0.01 mg/kg (0.1mg/1mL)IV/IO max of 1 mg every 3-5 mins

200

Adenosine: Adults and Pediatrics?

First dose: 6 mg rapid IV push; follow with NS flush; Second dose: 12 mg if required.

0.1mg/kg (max 6mg) IV/IO followed by 5-10 cc saline flush; Repeat 1-2 min at 0.2mg/kg (max12mg)IV/IO followed by 5-10cc saline flush

300

Amiodrone for: Stable wide-QRS tachycardia and Cardiac arrest?

First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of 1 mg/min for first 6 hours.

First dose: 300 mg bolus; Second dose: 150 mg.

400

Adults only, post cardiac arrest or for bradycardia with severe hypotension: Dopamine and Epinephrine?

Epinephrine IV infusion:2-10 mcg per minute.

Dopamine IV infusion: 5-20 mcg/kg per minute.

500

Lidocaine: Adults only for cardiac arrest and PVC's/V-Tach with a pulse?

Cardiac arrest- 1-1.5 mg/kg IV/IObolus→ may be repeated in 5-10 mins at 0.5-0.75 mg/kg with a total max of 3 mg/kg. Bolus is followed by a maintenance infusion drip of 1-4 mg/min post-cardiac arrest.

For PVC’s or V-tach with a pulse – 0.5-0.75 mg/kg IV/IO up to 1-1.5 mg/kg IV/IO and may be repeated with a total max dose of 3 mg/kg