Advanced Cardiac Life Support

Assess Responsiveness Unresponsive Call for code team and Defibrillator Assess breathing (open the airway, look, listen and feel for breathing)

If Not Breathing, give two slow breaths. Assess Circulation PULSE Give oxygen by bag mask Secure IV access Determine probable etiology of arrest based on history, physical exam, cardiac monitor, vital signs, and 12 lead ECG. NO PULSE Initiate CPR If witnessed arrest, give precordial thump and check pulse. If absent, continue CPR Ventricular fibrillation/tachycardia (VT/VF) present on monitor? NO Intubate Confirm tube placement Determine rhythm and cause. Arrhythmia YES VT/VF Go to Fig 2

Hypotension/shock, acute pulmonary edema. Go to fig 8

Bradycardia Go to Fig 5

Tachycardia Go to Fig 6 YES

Electrical Activity? NO Asystole Go to Fig 4

Pulseless electrical activity Go to Fig 3

Fig 1 - Algorithm for Adult Emergency Cardiac Care


Continue CPR. Confirm asystole by repositioning paddles or by checking 2 leads. Intubate and secure IV access.

Consider underlying cause, such as hypoxia, hyperkalemia, hypokalemia, acidosis, drug overdose, hypothermia. myocardial infarction.

Consider transcutaneous pacing (TCP)

Atropine 1 mg IV, repeat q3-5min up to a total of 0.04 mg/kg; may give via ET tube.

Consider bicarbonate 1 mEq/kg (1-2 amp) if hyperkalemia, acidosis, tricyclic overdose. Consider termination of efforts.

Fig 4 - Asystole

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