ACLS Cardiac Arrest Algorithm

Copyright ©2010 American Heart Association

Neumar, R. W. et al. Circulation 2010;122:S729-S767

ACLS Cardiac Arrest Circular Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

 Bradycardia Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

 Tachycardia Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

 Post-cardiac arrest care algorithm

Peberdy, M. A. et al. Circulation 2010;122:S768-S786

Acute Coronary Syndromes Algorithm

O'Connor, R. E. et al. Circulation 2010;122:S787-S817

Goals for management of patients with suspected stroke

Jauch, E. C. et al. Circulation 2010;122:S818-S828

 ACLS Code Drugs
Drug Indications
Adenosine/ Narrow PSVT/SVT
Wide QRS Tachy of
Adenocard uncertain cardiac origin
Amiodarone Vfib/pulseless VT,
VT with a pulse. May be
used for rate control of
WPW or atrial tachycardias.
Atropine Symptomatic sinus
bradycardia.
Calcium Chloride Known or suspected
hyperkalemia (renal fx).
Hypocalcemia after multiple
blood tx. Antidote for
calcium channel blockers or
beta blocker overdose
Dopamine Used for hypotension with
signs and symptoms of
shock or bradycardia
Epinephrine Cardiac arrest, VF, pulseless
VT, asystole, PEA
Symptomatic bradycardia,
severe hypotension,
anaphylaxis
Dosage
6 mg followed by 12mg in 1-2
min.
300mg IVP for cardiac arrest.
Consider repeating with 150mg
in 3-5 min.
150mg over 10 min for stable
VT, may repeat 150mg every 10
min as needed. Cumulative dose
of 2.2 IV in 24 hrs.
Slow infusion 360mg IV over 6
hrs, maintenance 540mg over 18
hrs. (0.5mg/min)
.5 mg IV every 3-5 min for
bradycardia, not to exceed 3 mg
Tracheal 2-3mg diluted in 10cc
NS.
8-16mg/kg IV for hyperkalemia
and calcium channel blocker
overdose.
Mixed 400mg/250D5W
2-10mcg/kg/min.
Cardiac arrest: 1mg of the
1:10,000 administered q 3-5 min
follow each dose with IV flush.
Bradycardia or hypotension use
a gtt.
Administration
Rapid IV push close to the
hub followed by a saline
bolus.
Draw up with filtered
needle. Administer drip with
filtered tubing.
Gtt infusion mixed
900mg/500 D5W.
1mg/min = 33.3cc/hr
.5mg/min = 16.6cc/hr
Half life is up to 40 days.
Do not give less than 0.5mg
IV.
May be given IV, IO, or ET
Does not work with heart
transplant patients due to
denervation.
Do not mix with sodium
bicarbonate.
IV line must be a good one.
Will cause extravasation
with infiltration
Do not mix with sodium
bicarbonate.
1mg/250cc: 1mcg/min = 15
cc/hr.
May be given IV, IO or ET
 Drug Indications
Magnesium Sulfate Torsades de pointes or
suspected hypomagnesemia.
Life threatening arrhythmias
due to dig toxicity.
Morphine Sulfate Used for treatment of
ischemic chest pain, acute
cardiogenic pulmonary
edema, anxiety
Decreases the myocardial
preload and causes
peripheral venous pooling.
Narcan/Naloxone Used to reverse respiratory
depression that results from
narcotics
Also used for coma of
unknown etiology
Procainamide Anti-arrhythmic for stable
wide QRS Tachycardia
Sotalol Hemodynamically Stable
Monomorphic Ventricular
Tachycardia
3rd Line Anti-Arrhythmic
Sodium Bicarbonate Preexisting hyperkalemia,
metabolic acidosis,
prolonged resuscitation.
Vasopressin May be used as an
alternative pressor to epi in
the treatment of Cardiac
Arrest instead of 1st or 2nd
dose of epi
Compiled by:
Rebecca Cass, NREMT-P
Dosage Administration
1-2 gm diluted in 10 cc D5W May cause fall in BP with
IVP if in cardiac arrest. rapid administration.
If not in cardiac arrest mix 1-2 Use with caution if renal
gm in; 50 to 100 cc D5W to failure is present.
infuse over 5 to 60 min.
Dosage should be in 1 to 2 mg Given slow IV over 1-2 min
increments up to 10 mg max
Precautions: respiratory
depression and hypotension
Dosage – 0.4 mg to 2 mg IV or IV or IO meds should be
IO and may be given ET given over 1 min.
Precautions: If given rapidly
IV/IO can cause projectile
vomiting
Patient may become
agitated or violent
20-50 mg/min End Points: Arrhythmia
suppressed, hypotension
ensues, QRS duration
increase >50%, max dose
17 mg/kg
100 mg over 5 min or Avoid if prolonged QT
1.5 mg/kg over 5 min
1 meq/kg IV bolus. Not recommended for
Repeat half dose q 10 min routine use in cardiac arrest
patients.
IV, IO 40 U IV push X 1 dose Do not give any epi for
only. 10 min after vosopressin is
ET 80U X 1 dose only given.
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