Jay Gurubalan

Sequence of actions for the urgent treatment of

cardiac arrest or other medical emergencies
BLS ACLS
ACLS

• Medical knowledge
• Medical gadgets & equipment
• Drugs
• Medical staff or trained personnel
ACLS – restart the heart

BLS aims to partially restore the flow of blood to brain and heart

ACLS aims to restart the heart

ACLS – take over and assign roles

Chest compression & Airway management

Cardiac Monitor (ECG) and intravenous access
Lead role and decision making
Assign Coder
Shock Delivery if needed
ACLS – attempt to restart
Keep the blood and air flowing
Restarting the heart is the first priority
Rhythm recognition
What cardiac arrest rhythm means?
What are cardiac arrest rhythms?
Is it a shockable or a non shockable rhythm?
Sequence of actions
If nothing works, identify the cause – to treat the cause
■ 3-Lead and MCL1 Electrode Placement
Lead I
White Black -150° av -30°
R L
+ MCL 1 av
I 0°

Lead III
Le

avF
ad

III

II
II
12
0°
90° 60°

Red (on thighi)

■ 12-Lead Electrode Placement

V1 V2 V3 V4 V5 V6 V5 V6

V1: Fourth interspace, just to the right of the sternum

V2: Fourth interspace, just to the left of the sternum
V3: Halfway between V2 and V4
V4: Fifth intercostal space, midclavicular line
V5: Anterior-axillary line, horizontal with V4
V6: Mid-axillary line, horizontal with V4
MCL1: Red lead on V1, black lead on left arm—monitor lead III
MCL6: Red lead on V6, white lead on right arm—monitor lead II
MC4R: Red lead on fifth intercostal space right midclavicular line, black lead on
left arm—monitor lead III

ACLS ACLS ACLS ACLS

Recognition of Core Electrocardiogram Arrest Rhythms
This Photo by Unknown Author is licensed under CC BY
■ Cardiac Arrest
Shout for help, begin CPR (30:2, push hard and fast
at ≥100/min, minimize interruptions), give O2, attach ECG.
YES Shockable Rhythm?
VF or VT
Defibrillate 120 J–200 J
Biphasic (or 360 J
monophasic, or AED)
Continue CPR immediately × 2
minutes. Start IV/IO.
VF/VT?
Defibrillate
Continue CPR × 2 minutes
Epinephrine, 1 mg IV/IO,
repeat every 3–5 minutes, OR:
Vasopressin 40 Units IV/IO (single
dose only)
Consider advanced airway
(ET tube, supraglottic airway)
Ventilate 8–10 breaths/minute with
continuous compressions
Use waveform capnography:
If PETCO2 <15, improve CPR
VF/VT?
Defibrillate
Continue CPR × 2 minutes.
Amiodarone, 300 mg IV/IO
(may repeat once 150 mg
in 5 minutes)
Consider reversible causes.*
If ROSC (pulse, BP, PETCO2
≥40 mm Hg),
see ROSC algorithm, next page.
ACLS ACLS
NO
Asystole/PEA
Continue CPR immediately
× 2 minutes. Start IV/IO.
Epinephrine, 1 mg IV/IO, repeat
every 3–5 minutes, OR:
Vasopressin, 40 Units IV/IO (single
dose only), consider advanced
airway (ET tube, supraglottic airway)
Ventilate 8–10 breaths/minute with
continuous compressions
Use waveform capnography:
If PETCO2 <15, improve CPR
Asystole/PEA?
Continue CPR × 2 minutes
Consider reversible causes.*
If ROSC (pulse, BP, PETCO2
≥40 mm Hg),
see ROSC algorithm, next page.
*Reversible Causes
■ Hypoxia
■ Hypovolemia
■ Acidosis
■ Hyper-hypokalemia
■ Hypothermia
■ Coronary thrombosis
■ Pulmonary thrombosis
■ Cardiac tamponade
■ Tension pneumothorax
■ Toxins
ACLS ACLS
 ACLS – reversible causes
5H 5T
• Hypoxia • Toxins
• Hypovolemia • Tamponade
• H+ • Thrombosis - coronary
• Hypothermia • Thrombosis – pulmonary
• Hyper or Hypokalemia • Tension pneumothorax
 Endotracheal intubation

§ Cardiac arrest when bag-mask ventilation is not possible or is

ineffective, or if a protected airway is needed
§ Responsive patient in respiratory distress or compromise
§ Patient unable to protect airway (eg, coma, areflexia, or cardiac arrest)
BRADYCARDIA
TACHYCARDIA
ACUTE CORONARY SYNDROME
QUESTIONS