Adult Basic Life Support Algorithm for Healthcare Providers hana ean + Check for responsiveness. + Shout for nearby help. + Activate emergency response ‘system via mobile device e Provide rescue breathing, | ‘bveathavery6 seconds or No normal _/, \ecktornobreating \ breathing ‘oronly gasping and check \ pulse felt ‘ulse(simutancoushy. > pu dofinitely tet \. within 10 seconds? cor only gasping. pulse not felt Bythstimeinallscenarios, emergency response system or backup is activated, ~ and AEO andemergency equpment are Fetvevedor someone isretieving them, { ‘start CPR ) + Performeyctes of 30 compressions and 2 breaths | _ USeAEDassoonasitisevaisble, AED arrives. | Zo Chockstythm. >. ee yh? Shockabied p Yes, a shockabl no * Give 1 shock. Resume CPR + Resume CPR immodiately for immediately for 2 minutes | -2minutes(untipromptedby AED _} (untiiprompted by AED to allow toallowshythm check), | rhythm check) + Continuo until ALS providers take | + Continuo untilALS providers take over orvictin startstomove, | | overor victim starts tomove. % cman) y ©2020AmercanHeart Assocation‘Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA) YY strcrr + Greorygen tatacn T . CPR2min + 1yto seeoss + Epinephring every 3-5 min Conser + Hao signs of etuinot spontaneous creultion (ROS) goto 100° 1 + WROSC. goto Post-Carciae rest Care + Consider appropriateness ‘of continved resuscitation ‘©2020AmercantinwtAnsecston = + Pusnnardttienst inches (Senlandtast(00-120!mer) | _ andatow completo chesteecot | + Hamre teapiosin | « Avowercessve vetsaton | + Change compressor every |" zmniten sooner ttatued + Mipoodvancedarway. 202 + Quanttaowewavetorm expncg apy PICO, ower decreasing reassess CPR ‘Shock Energy fr Defrittion Biphasic Man | | Sumer, | | {se moun aatabie Secondandaubsequent doses shouldbe equivalent andtogher ‘doses oy be conadared + Menophasie 50. * Epinephvine V0 dose: ecesinetvno dose: Festeone 5 Second dove 05:0 78 af. + Endotocnetenabatence ur Sragutte avanceasrwey i See Erumeescenent Over bremnereySoecoras oteeomamancncentns cuscheteompreseers Returnot spontaneove Cec Rssmadeednesare ‘ret aorto can sto type ston + Seetintocstoutpre ecseon‘Adult Cardiac Arrest Circular Algorithm + Pushhadfatleast inches [5 en and fast (100-T20/mi]and ‘aw complote chestrecod, | + Misniz interruptions in compressions. + Avoidexcessive entiation, + Change compressor every 2 minutesor sooner fatigued. + tno vanced away 302 compression ventiaton ato. * Quantitative waveform capnography = HCO, lot oF decreasing, reassess CPR quay. eno otc + Biphasic: Monufacturertecommendation(eg.intioldoseot 120-200 dh: unknowin use maximum avalable. Second and subsequent doses should be equvalent, and higher doses may beconsiderod, * Monophasie:360J * Epinephrine VINO dose: mg every3-5 minutes + Amiodarone V0 dose:Fis\ dose: 300 mgbolus. Second ose: 150mg, or + Udocaino V0 dose:Fust dose: 1-1 mgikg Second dose: 05-015 mghkg | + Excoachealinvbatonesupagltteadvancedaxway . Waveform capnography or capnometrytocconfirm and monitor ETtubeplacement . ‘Once advanced airway:n place, que ‘Voreathevery6 seconds {obrathimyithcontmuaus chest compressions TUE Cece) A ise and blood pressure + Abvuptsustanedineease nPeto, typcaly 0 mmHg) + Spontaneousarealpressrevavesvithinvacteral | entotrg Hypovolomia + Tension pneumothorax. + Hypo + Tomponade,cardiae | + Hygrogenionfacdoss) + Toxins | + Hyposyperkalemia * Thrombosis, pulmonary + Hypothermia + Thrombosis coronary (o2020AnereanbanrssostenAdult Bradycardia Algorithm | Atropine IV dose: | Fist dose:1 mg bolus, | Repeat every 3-5 minutes Maximum:3 mo. | | Dopanine¥ntusion | Usual infusion rate is | 5-20megikapermnute Tirtetopaentiesponse, | | taper sioniy Epinephrine V infusion: 2-40megperminuteintusion, Titatetopatentresponse | causes: + Myocardalischemiay infarcton + Drugs/toxicologicte, calcium-channal blockers, | betablockers digo + Hypoxia | + Electrolyte abnormality (9, hyperkalemia) ©2020Amercan Heart AssociationAdult! st Adult Tachycardia With a Pulse. Algorithm Persistent tachyarhythmia causing: ‘Synchronized cardiove | Raft you spcte device's recommended enegyeel. | masa fist shock succes. | AdenosinelV dose: | | Fst dose: 6 mgrapidVpustefolow withNS fish, | Second dose: 12mg required, | Antti lntsions for tbl Wie-ORS Tatyana | Procainamide V dose: 20.50 mgénin nti arrhythmia suppressed, hypotension ensues (QRS duration increases >60% ormanmum dose 17 Maintenance infusion: I-4mgimin, Avid prolonged GT or CH. ‘AmiodaronelV dose: Fist dose: 150mg over 10 minutes. Repeat as needed VT recus, | Folomby matenanceinfusenof malnintorrst hous, SotaolV dase: | 100mg (1.5 mg/kg) over 5 minutes, Avoid ifprolonged QT,Adult Tachycardia With a Pulse Algorithm Synchoized cardioversion: Retr your speci ences rcommended energy evelto masize ist shock success, | ‘Adenosie|V dose: | | First dose: 6 mgrepiV pushfolow with NSflush Second dose: [2g frequre. | “AntarythmicInfsions for Stable Wide QRS Techycarcla ProcainanidelV dose: 20-0 minuntl ay hm suppressed hypotension ensues, | ORS duration increases >50%eormanimum dose 17 mglkg gen, | Mantenance fusion: 1-4 min. Avoid prolonged GT or CF. | AmiodaroelV dose: | Fist dose: 150 mgover TOmirutes Repeat as neededifVT recurs. Felluby maintenance nfuson of | mgiminforfrst hows, Sotalol V dose 100mg(1S gia) ver S minutes Acid prolonged GT.Cardiac Arrestin Pregnancy In-Hospital ACLS Algorithm —\ am | «High-quality CPR + Defibeilation whenincicated | + Teamplonning should bedonein | «Other ACLSinterventions colaborationwith the obstetric, | | neonatal emegency, anesthesiology itensivecare, andcardacarestserees, + Pits for pregnant women incardacaressholincude provision of high-quality CPRang ree of aortocavalcompressionvith ‘nteralterine displacement + Thegoalofperimortemcesaean Geliveryis to improve makernal and {etatcones. «Aga prtormperiortemcesieon daiveryinSrinutes, depending on provderresoucesandskilsts, + Inpegrancy ifieu aivay ‘scommon Usettemast enpentneed poder. + rovidendatachalinubatonar supragteabvance avy. - + Pomodoro: San ) agnomt conti aré monte oes Corts CA : ETwbepocemet, High-quality CPR z « Onceadvarcedsinaysinpace Delbiatan whenindeated ge eamereryscots + Other ACLSinterventions 0 iobeatshin withcontnous i 0 ‘chest compressions. ‘Asgomble maternal cardac arrest team Ree ec acll Ca | a Anette compcaions 8 Being C Cardiovascular | 0 Ongs E Embolic F Fever 6 Generalnoncbstetrie causes of cardiac arrest Hs angT's) HHypeenson Neoratalteamtoreceve neonate ‘eauzpAnercanHewtassoion ozazo Ameren Assecaten Twromboss coronary ee SlAdult Post-Cardiac Arrest Care Algorithm Initial ‘Stabilization Phase ‘©2020 AnerecandesrtAsiavaten rena Resusetationis ongoing ding he | post ROSC phase andmanyer nese otitis canoccur concurrently Homever fprontaavonss necessary, folow those steps: Airway management: | Wavetorm capnography or | eaprometytocontemondmonter endotracheal tubo placement | «Manage espratery rameters: Tacate Fi, for Sp0; 92%-98%:start | derObveathsimnctratetoP9Co, et | 3o4ammnp + Manage hemodyram parameters: | Administer crystaloid and/or | tasopressorerotone f0goat Systoledoospressue>90%m Hg | or meanarteragressute>65 mmiig Gimnoo acme! Pere raed ‘These evaluations should be done concurrently so that decisions on | targeted temperature management (TIM recewe high peiority as ‘cardiac interventions. Emergent cardiac intervention: Early evatvatonof 12608 ‘etectrocardiogram (ECG): conser hemodynamics or decisionon | earaacinorvention | « Trait patentisnot folowing commands. stort TTeas soon os possible:beginat 32-36°C for 24 | ours byusinga cooling device with fecadaek loop | + Other enticaleare management = Continuously monitor core temperature esophageal rectal biadcer) = Mantainnormosia, normocapnia, | euaiveemia = Provide continuousorintermitent | electroencephatogram (EEG) ‘monitoring Proven tective ventiation | Hypovoiemia | Hypoxia Hydrogenion (acidosis) | | HypokatomiaMhyperkalemia Hypothermia Tension pneumothorax ‘Tamponade, cardiac | Toxins | | Trrombos's. pulmonary | | Trrombosis. coronaryComponents of Post-Cardiac Arrest Care | oxygenation and ventilation jeasure onygenaton and target normaxemia 94%-99% (0 CMTS mormalaporopriate onygen Saturation To Weasure aa target Po, prorat the paints underving condition oe etm exposure to severe rypecapna or typocapni. [9 Hemodynamic monitoring - Set specie hemodynamic goals during post-cardacarest care and eve sly. [9 [Monto caro teamed [o Monitor arterial blood pressure. [9 Monitor serum lactate rin ‘output, and central venous oxygen saturation t0 nelp guide therapies. | a i] Use parenteral lid bolus with or without inotropes or vasopressors 10 monn? jas Systolic Blood pressure greater than the fith percentile for ageandSO% ‘Targeted temperature management (TTM) . ‘Measure and continuously monitor core temperature. o Prevent and treat fever immediately after arest and during rewarming, a i/patentis comatose apply TTM (320-940) folowed by (360-37 5) 6 only TTM(36°C-375°C a Prevent shivering. a Monitor blood pressure and treat hypotension during rewarming a ‘Neuromonitoring iFpatenthas encephalopathy and resources are avaiable, ON with continuous electroencephalogram. | Treat seizures. a Consider early bran imaging to dagnose treatable causes of CarsaC ATES o Electrolytes and glucose [Measure blood gucoseandavoid npogieera o emai eleavoynes wivin normal rongesto aval possible ie-veatenng ar ys, a Sedation Treat with sedatives and arvioytics. a Prognosis rmaye consider tiple moda (lnicalandther over any single preicve 21% a Remember that assessments maybe modfied by TTM or induced hypothermia. a Consider electroencephalogram in conjunetion with other factors within the fst 7 daysafter cardiacarrest. | O o Consider neuroimaging such as magnetic resonance imaging during the first 7 GoyS,| Pediatric Cardiac Arract **-Pediatric Cardiac Arrest Algorithm i Start CPR Begin bag-mask entiation and give oxygen | + Pushnaratyotanteropostenor + attach moniorietbtator dametecotchosdandtace {100-120iminond stow complete chestrecol + Mnnmae nteruptionsin compressions + Change compressor every 2minvtes.or sooner athgued + Iteoadvancedarmay. 152 ») compressonventionrato | @) + Mradvancedaeway prove VFIpVT ‘Asystole/PEA Continuous compressions and | | gweabeeath every 29second Sco 2 shock gg Epinephrine Furst shock 2 uKg 1 ASAP | 5 Secondshock4Jikg | eas + Subsequent shocks b4Jng, | J mera ) ® >) | “acre Wargo ean Siee CPR2min ~ — CPR2min ees Tw aces sone: ine ca + Epinephrine every 3+ a || Epinephrine v0 do | + Consider advanced 0.01 mg/kg (0.1 mL/kg of the (Bway andeapnography 04 mg/mL concentration), | Z bee a | uaccose 1g Rhythm Repeat every minutes ieee Mnoivno acéess may ge ‘endotraches! dose: 01 marag (0.1 mU/Agot the t maim. concentration) | + Amiodarone VIO dose: Smalkgbouusduringearise | attest. May topeatupto Btotaldosestorrettactory | \VFiputseless VT or ae oa ice ~ CPR2min + Epinophrine every 3-5 nin | + Consider advoncedalrway Lidocaine wn dose: wy Initat 1 mghkg loading dose CPR2 min Teatreversible causes ings) + Endotrachealintubstionor Supragiottic advanced away + Wavotorm capnograptiy or capnometty to confirm ant monitor ETtubeplocement | No_/ Rbythm \\ shockabie? ole irons CPR2min +» Hydrogenion facidosis) | Saemcia coo sce “iter eclsoumoretin corona 2 antes (2. (32) * Trrombou's, pumonary | + Heo signs of retuznot spontaneous icotaziin| = tiveremn cocoon ckculation (ROSC), goto 10 C 2 + IROSC. go toPost-Cardic rest Coro checklist (©2070AmencannewtArsceationPediatric Basic Life Support Algorithm for Healthcare Providers—Single Rescuer Look for no breathing ‘or only gasping and check pulse (simultancously). Is pulse dofinitoly felt within 10 seconds? Start OPR | + trescwor: Perform cycles of | 30comprossions.and2 breaths. Whon second rescuer arrives, pertorm cycles of 15 compressions No, nonshockable * Give 1 shock Resume CPR + Resume CPRimmediately or iruedlately for 2 mien 2minutesunttpromptedby AED | ‘— (unt prompted by AED to allow toallowshythm check) pgtrnrrienses | Bere ec eee Geese) nanos (© 2020AmercanMeart AssociatonPediatric Basic Life Support Algorithm for Healthcare Providers—2 or More Rescuers breathing, / Looktorno breathing ‘0r only gasping and check pulse (simultaneousty). Ispulse definitely fet within 10 seconds? HR <60/min with signs of poor No breathing cor only gasping, pulse not felt ( start CPR + First rescuer performs cycles of ‘30compressions and 2 breaths. | + Whensecond escuerreturns, perform cycles 15 compressions ‘and 2 breaths. + Use AEDas soonasitis available, Nill tee taal in eset Check thythm, <——______ Shockabl rhythm? No, nonshockable (+ Gwe shock Resume CPR | « Resume CPRimmedatelyfor immeciatlyfor2 minutes | 2minutesuntipromptedby AED ec aimocaml emer | stythm check. || + Continve unt ALS providers take | + Cintas proviestake veo the child startstomove. iets Sletanlaner ‘over or the childstartstomove. (© 2020AmercanHeartAssociton ee aPediatric Bradycardia With a Pulse Algorithm {aE eee poems pas ais start CPRIT HR <6O/min espite oxygenation and ventilation. | Epinephrine 1V/10 dose: | 0101 mgrg (03 mL/ag ofthe | 03 mgnnt concentration. Ropest every 3-S minutes. tind accor not avasabie butendotrocheal ET tube inpiace. my give ET dose: 04 manag (Ot meagot the ‘Tmgimt concentration). Atropine VO dose: 0.07 mgraq, Mayrepeatonce, Minimum dose 01 m9 29d maximum singie dose 0.5 m9. ‘= Hypothermia | + Hypoxia | Goto Pediatrie | + Medications el (© 2070 AmaricanHeart AssociationPediatric Tachycardia With a Pulse Algorithm Cardiopulmonary ‘compromise? + Aculelyaltered ‘mental status {20.09 see) itnotettectve increase | 102419. Sedateit ‘needed, but con't Beginwith0S-1 ig, | | carcioversion. | ‘Adenosine W/O dose | + Fist dose:01 mgrag | tapid bolus (maximum: 6mq) + Second dose: .2mg/Kgrapidbovs | maximum second | dose: 121mg)