ACLS algorithms

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  1. 1. Cardiac Arrest Circular Algorithm 2 minutes Drug Therapy access If VF/VT Shock Shout for Help/Activate Emergency Response Doses/Details for the Cardiac Arrest Algorithms Drug Therapy Return of Spontaneous Circulation (ROSC) - Hypovolemia - Hypoxia - Hydrogen ion (acidosis) - Hypo-/Hyperkalemia - Hypothermia - Tension pneumothorax - Tamponade, cardiac - Toxins - Thrombosis, pulmonary - Thrombosis, coronary CPR Quality Advanced Airway*** Supraglottic advanced airway or endotracheal intubation Waveform capnography to confirm and monitor ET tube placement 8-10 breaths per minute with continuous chest compressions Epinephrine IV/IO Dose: 1 mg every 3-5 minutes Vasopressin IV/IO Dose: 40 units can replace first or second dose of epinephrine Amiodarone IV/IO Dose**:First dose: 300 mg bolus. second dose: 150 mg Reversible Causes Shock Energy Biphasic: Manufacturer recommendation (eg, initial dose of 120-200 J): if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered Monophasic: 360 J CPRSTART Push hard ( 2 inches [5cm]) and fast ( 100/min) and allow complete chest recoil. Minimize interruptions in compressions.* Avoid excessive ventilation Rotate compressor every 2 minutes If no advanced airway, 30:2 compression-ventilation ratio Quantitative waveform capnography If PETCO2 10mm Hg, attempt to improve CPR quality Intra-arterial pressure If relaxation phase (diastolic) pressure 20 mm Hg, attempt to improve CPR quality. Pulse and blood pressure Abrupt sustained increase in PETCO2 (typically 40 mm Hg) Spontaneous arterial pressure waves with intra-arterial monitoring Post-Cardiac Arrest Care Circulation (ROSC) Return of Spontaneous Check Rhythm Attach Monitor/DefibrillatorGive Oxygen Epinephrine every 3-5 minutes Amiodarone for refractory VF / VT Consider Advanced Airway Quantitative waveform capnography Treat Reversible Causes (c) ACLS Training Center 877-560-2940 support@acls.net(c) Complete your ACLS recertification online with the highest quality courses at http://www.acls.net and use promo code PDF2014 during checkout for 15% off. IV/IO
  2. 2. Epinephrine every 3-5 min Consider advanced airway, capnography Amiodarone Treat reversible causes Start CP... R Cardiac Arrest Algorithm YES Shock* Asystole/PEA Treat reversible causes NO NO YES Attach Monitor/Defibrillator Give Oxygen Shout for Help/Activate Emergency Response RhythmShockable? RhythmShockable? Shock RhythmShockable? RhythmShockable? RhythmShockable? Shock Go to 5 or 7 If ROSC, go to Post- Cardiac Arrest Care. 2 3 4 5 6 7 8 9 10 11 12 VF/VT 1 Y N YY N N YY N N Y YY CPR 2 min CPR 2 min CPR 2 min CPR 2 min IV/IO access Epinephrine every 3-5 min Consider advanced airway, capnography IV/IO access If no signs of return of spontaneous circulation (ROSC), go to 10 or 11. (c) ACLS Training Center 877-560-2940 support@acls.net(c) Complete your ACLS recertification online with the highest quality courses at http://www.acls.net and use promo code PDF2014 during checkout for 15% off. CPR 2 min
  3. 3. (c) Symptoms Suggestive of Ischemia or Infarction Oxygen (If O sat