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ACLS Algorithm

ACLS Algorithm

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Published by: cool kips on Aug 24, 2010
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05/17/2012

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Initiate CPR at cycles of30 compressions and 2breaths until defibrillatorarrives.Assess ResponsivenessNo movement or responseCall for code team and DefibrillatorOpen the airway, look, listen and feel forbreathing)If Not Breathing,give 2 breaths that make chest riseCheck pulse
PULSENO PULSE
Give oxygen by bag mask. One breathevery 5 to 6 seconds.Recheck pulse every 2 minutesSecure IV accessDetermine probable etiology of arrestbased on history, physical exam,cardiac monitor, vital signs, and 12lead ECG.Defibrillator arrives.
Check RhythmShockable rhythm?
Hypotension/shock,acute pulmonaryedema.Go to fig 5
NotshockableShockable
Asystole or PulselessElectrical ActivityGo to Fig 2VentricularTachycardia orVentricularFibrillationGo to Fig 2ArrhythmiaBradycardiaGo to Fig 3TachycardiaGo to Fig 4
Fig 1 - Basic Life Support AlgorithmBasic Life Support Algorithm
Advanced Cardiac Life Support
 
Ventricular Fibrillation orVentricular TachycardiaAsystole or PulselessElectrical Activity
Fig 2 - Pulseless Arrest Algorithm
Assess Airway, Breathing, Circulation, Differential Diagnosis; call for helpGive CPR and oxygenAttach monitor/defibrillatorResume CPR for 5 cyclesWhen IV/IO available, givevasopressor
Epinephrine
1 mg IV/IO
or
May give 1 dose of
vasopressin
40 UIV/IO to replace first or seconddose of epinephrineConsider atropine 1 mg IV/IO forasystole or slow PEA rate. Repeatevery 3 to 5 min, up to 3 dosesCheck rhythm
Shockable rhythm?PULSELESS ARREST
Continue CPR
Give 1 shock
Manual biphasic: Same as first shock or higher dose.Monophasic: 360 JResume CPRConsider antiarrhythmicsduring CPR:
Amiodarone
300 mg IV/IO once, then 150 mg IV/IO once
or
 
Lidocaine
1-1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO, max 3doses or 3 mg/kgConsider magnesium, loading dose 1 to 2 g IV/IO for torsades de pointesAfter 5 cycles of CPR, go to box 5 above
Give 1 shock
Manual biphasic: 120-200 JMonophasic: 360 JResume CPR
Give 5 cycles of CPR
Check rhythm
Shockable rhythm
?Continue CPR
Give 1 shock
Manual biphasic: same as firstshock or higher doseMonophasic: 360 JResume CPRGive vasopressor during CPR
Epinephrine
1 mg IV/IO. Repeatevery 3 to 5 min orMay give 1 dose of vasopressin 40U IV/IO to replace first or seconddose of epinephrineCheck rhythm
Shockable rhythm?Shockable
No
Give 5 cycles of CPRShockable
NoIf asystole, go to Box 10If electrical activity, checkpulse. If no pulse, go tobox 10Ifpulse present, beginpostresusitation careCheck rhythm
Shockable rhythm?Give 5 cyclesof CPR
Go toBox 412345678910
Shockable
No
ShockableNot Shockable
 
AdequatePerfusionPoor PerfusionBRADYCARDIA
Maintain patent
Airway
, assist Secure IV access
Breathing
as neededReview historyGive
oxygen
Monitor ECG, pulse oximeter andblood pressureBradycardia (<60 beats/min) and inadequate forclinical condition
Signs or symptoms of Poor Perfusion caused by bradycardia?
(eg, onfusion, delirium, lethargy, chest pain, hypotension or other signs of shock)• Initiate
transcutanous pacing
for high-degree block (type II second or 3rd degreeheart block, wide complex escape beats,MI/ischemia, denervated heart(transplant),new bundle branch block)• Consider
atropine
0.5 mg IV, repeat q5min toa total dose of 3 mg. Initiate pacing ifbradycardia continues.• Consider
epinephrine
2-10 mcg/min IVinfusion or dopamine 2-10 mcg/kg per min IVinfusion while awaiting pacer or if pacingineffectiveInitiate transvenous pacingTreat contributing causesObtain cardiology consultation
Fig 3 - Bradycardia Algorithm (with patient not in cardiac arrest).
Observe and Monitor
Reminders
• If pulseless arrest develops,go to Pulseless ArrestAlgorithm• Search for and treat possiblecontributing factors:
H
ypovolemia
H
ypoxia
H
ydrogen ion (acidosis)
H
ypo/hyperkalemia
H
ypoglycemia
H
ypothermia
T
oxins
T
amponade, cardiac
T
ension pneumothorax
T
hrombosis (coronary orpulmonary)
T
rauma (hypovolemia,increased ICP)

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