ACLS Study Guide

Epinephrine 1 mg every 3 to 5 minutes (NO max dose). Typically for PEA, Asystole.. Possibly, Brady
Atropine 0.5-1mg up to 3 doses – For Brady
Adenosine 6mg or 12 mg for adult SVT. Initial dose 6MG rapid IV, follow up repeat or 12. May
take 20-60 for pause to occur.
Amiodarone Initial 300mg, follow up is 150mg (max 450 for an adult) for ventricular rhythms
Lidocaine Initial dose 1mg/KG follow up 0.5/kg (max 400-450 weight dependent)

NSR, PEA, SB, ST, SVT, AFIB, AFLUTTER, VT, VF, Aystole, STEMI

Two sets of twins

PEA and Asystole… Epi 1,3,5 and chest compressions

Pulseless Vtach and VFIB.. Defib!! (f no pulse, there is nothing to sync with so defifb)

Vtach Priority is checking if they have a pulse!! With a pulse, sync cardiovert, or amio 300 then
follow up 150

1. Unstable- Call rapid team first, then code team and ship the patient to critical care. If your
patient doesn’t have IV access, establish it as soon as possible. 2 LARGE BORE IVS are the best!
You can go ahead and hook them up to the monitors and bring the crash cart near or at bare
minimum locate it! You can never be too safe.
2. IO access is acceptable but must be replaced within 24 hours with a more long term access.
With IO access, you will meet resistance. Be sure to flush with 5 to 10mls of saline. AVOID IO of
patient has bone disease such as osteoporosis or swelling/redness around the potential
insertion site.
3. Bystander and you witness cardiac arrest- Call 911 first and the initiate CPR. (HIGH QUALITY BLS,
30x2). WITH AN ADULT CALL FOR HELP FIRST, WITH A CHILD YOU INITATE CPR.
4. Ensure communication is clear throughout the team. Acknowledge request of the team leader.
5. First BLS assessment, (ABCDE: Airway, Breathing, Circulation, Disability and Exposure),
Secondary (SAMPLE: Signs and Symptoms, Allergies, Medications, Past Illness, Last PO intake,
Events Leading Up to Illness!
6. Before conducting any assessment ALWAYS make sure the scene is safe.
7. When you are not sure if you can feel a pulse, START CPR.
8. Hs& Ts
-Hypoglycemia(D50 unconscious, if awake orange juice with 2 sugars possibly), Hyperglycemia
Hypoxia (administer o2 at 90%), Hydrogen Ion (acidosis).. bicarb, Hypo/hyperkalemia,
Hypothermia
-Tension pneumothorax (DECREASED OR ABSENT BREATH SOUNDS ON 1 SIDE), Tamponade
(cardiac), toxins, Thrombosis (pulmonary or coronary)
 9. Hypovolemia and hypoxia are the two most common causes of PEA.
10. If an H or T is the problem. Correcting it, is now a priority.
11. If a patient has an advanced airway, don’t stop compressions for breaths. Only stop for pulse
checks, analyzing rhythms and to shock. YOU DON”T HAVE TO STOP GIVING BREATHS TO DO A
PULSE CHECK.
12. Acute Coronary Syndrome- ONA (Oxygen, Nitro, Aspirin) 2-4 baby asprin, 1 adult asprin
13. STEMI- ST elevation, NSTE-ACS (ST depression or Twave inversion. Fibrinolytic therapy ASAP for
rapid reperfusion.) Non stemi (repeat your 12 lead with n-stemi) 1 nitro can be given every 3 to
5 minutes.
14. Low-Intermediated-risk ACS (Angina) Great opportunity to educate the patient on s/s and
encourage them to go see a PCP or cardiologist for work up.
15. STROKE- General Assessment (ASAP), B-FAST, (Balance, Facial Droop, Speech, ARM, TIME to go
to the hospital.) Neuro Assessment, GET TO CT within 25 minutes, interpretation should take no
more than 45 minutes. Treat ischemic (TPA) or hemorrhagic per facility protocol.
16. Vfib-Dfib.Vtach SHOCK
17. No pulse (CPR Rounds for 2 minutes. No pulse means nothing to shock.)
18. Compression interruptions should be no more than 10 seconds.
19. Heart Code Basic
a. In a perfect world there is 6+1, 1 person writing notes, 1 person pushing meds, 2
compressors, 1 sealing the mask, 1 squeezing the bag and 1 CALLING THE CODE.)
b. How do you squeeze the bag? (half or enough to see the chest rise because too much could
decrease venous return.)
c. BLS assessment (no more than 10 seconds)
d. Pulse- Monitor
e. No Pulse (call for help, start compressions BEGIN BLS, Grab Crash Cart)
f. EPIEPHRINE 1MG IV/IO AS SOON AS ACCESS IS ESTABLISHED. IF YOU GIVE EPI, AND STOP
CPR AND THE PATIENT HASN’T RETURNED TO ROSC, YOU HAVE JUST MADE A PUDDLE.
DON’T STOP CPR UNTIL YOU HAVE A PULSE. Repeat epi every 3-5 minutes.
g. CHECK FOR PULSE, IF NO PULSE SHOCK, CONTINUE CPR AND PUSH AMNIODARONE
300MG.
h. If amiodarone isn’t available, lidocaine is next.
i. FOR TORRSADES, 2G MAGNESIUM.
j. Post code, follow the post cardiac arrest algorithm outlined by YOUR facility.
20. Amniodorone is for ventricular rhythms. The initial dose is 300. The follow up dose is 150. Max
450 within 24 hours.
21. PEA- Start CPR, there is no PULSE. CPR and EPI 1, 3, 5

DO NOT STOP CPR TO PUSH DRUGS!

22. You cannot shock asystole. There is nothing to shock. Give 1mg of epi and compressions.
23. Bradycardia- .5mg Atropine (BUT ONLY IF SYMPTOMATIC) Dopamine and Epi options.
24. Tachycardia can turn into SVT. SVT can turn into unstable SVT. Unstable SVT can lead to VTACH.
25. SVT- Adenosine 6 IV SLAM. You will get a 6 second pause. Don’t panic until your 6 seconds has
passed.
 STV, Adenosine Six, IV Slam, 6 Second Pause (Remember these S’s) if you don’t pulse after 6
seconds start cpr.
26. Unstable tachycardia could show Hypotension, AMS, Shock, Ischemic Chest Discomfort and
AHF.

You must quickly determine if the tachycardia is causing the symptoms or if distress or AMI (acute
myocardial infarction) is causing the symptoms. Treat the cause!