Adult Cardiac Arrest Learning Station Checklist (VF/pVT)

Adult Cardiac Arrest Algorithm (VF/pVT)

1
CPR Quality
Start CPR
• Give oxygen • Push hard (at least 2 inches
• Attach monitor/defibrillator [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
2 9 compression-ventilation ratio.
VF/pVT Asystole/PEA • Quantitative waveform
capnography
– If Petco2 is low or decreasing,
reassess CPR quality.
3 Shock Epinephrine Shock Energy for Defibrillation
ASAP
• Biphasic: Manufacturer
4 10 recommendation (eg, initial
dose of 120-200 J); if unknown,
CPR 2 min CPR 2 min use maximum available.
• IV/IO access Second and subsequent doses
• IV/IO access
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
capnography • Monophasic: 360 J

Rhythm No Drug Therapy

shockable? • Epinephrine IV/IO dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes • Amiodarone IV/IO dose:
shockable?
First dose: 300 mg bolus.
5 Shock Second dose: 150 mg.
or
No Lidocaine IV/IO dose:
6 First dose: 1-1.5 mg/kg.
CPR 2 min Second dose: 0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
nometry to confirm and monitor
Rhythm No ET tube placement
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths/min) with continu-
Yes ous chest compressions

7 Shock Return of Spontaneous

Circulation (ROSC)

8 • Pulse and blood pressure

11
• Abrupt sustained increase in
CPR 2 min CPR 2 min Petco2 (typically ≥40 mm Hg)
• Amiodarone or lidocaine • Spontaneous arterial pressure
• Treat reversible causes
• Treat reversible causes waves with intra-arterial
monitoring

Reversible Causes
No Rhythm Yes
• Hypovolemia
shockable? • Hypoxia
• Hydrogen ion (acidosis)
12 • Hypo-/hyperkalemia
• Hypothermia
• If no signs of return of Go to 5 or 7 • Tension pneumothorax
spontaneous circulation • Tamponade, cardiac
(ROSC), go to 10 or 11 • Toxins
• If ROSC, go to • Thrombosis, pulmonary
• Thrombosis, coronary
Post–Cardiac Arrest Care
• Consider appropriateness
of continued resuscitation
© 2020 American Heart Association
Adult Cardiac Arrest Learning Station Checklist (Asystole/PEA)

Adult Cardiac Arrest Algorithm (Asystole/PEA)

1
CPR Quality
Start CPR
• Give oxygen • Push hard (at least 2 inches
• Attach monitor/defibrillator [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
2 9 compression-ventilation ratio.
VF/pVT Asystole/PEA • Quantitative waveform
capnography
– If Petco2 is low or decreasing,
reassess CPR quality.
3 Shock Epinephrine Shock Energy for Defibrillation
ASAP
• Biphasic: Manufacturer
4 10 recommendation (eg, initial
dose of 120-200 J); if unknown,
CPR 2 min CPR 2 min use maximum available.
• IV/IO access Second and subsequent doses
• IV/IO access
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
capnography • Monophasic: 360 J

Rhythm No Drug Therapy

shockable? • Epinephrine IV/IO dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes • Amiodarone IV/IO dose:
shockable?
First dose: 300 mg bolus.
5 Shock Second dose: 150 mg.
or
No Lidocaine IV/IO dose:
6 First dose: 1-1.5 mg/kg.
CPR 2 min Second dose: 0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
nometry to confirm and monitor
Rhythm No ET tube placement
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths/min) with continu-
Yes ous chest compressions

7 Shock Return of Spontaneous

Circulation (ROSC)

8 • Pulse and blood pressure

11
• Abrupt sustained increase in
CPR 2 min CPR 2 min Petco2 (typically ≥40 mm Hg)
• Amiodarone or lidocaine • Spontaneous arterial pressure
• Treat reversible causes
• Treat reversible causes waves with intra-arterial
monitoring

Reversible Causes
No Rhythm Yes
• Hypovolemia
shockable? • Hypoxia
• Hydrogen ion (acidosis)
12 • Hypo-/hyperkalemia
• Hypothermia
• If no signs of return of Go to 5 or 7 • Tension pneumothorax
spontaneous circulation • Tamponade, cardiac
(ROSC), go to 10 or 11 • Toxins
• If ROSC, go to • Thrombosis, pulmonary
• Thrombosis, coronary
Post–Cardiac Arrest Care
• Consider appropriateness
of continued resuscitation
© 2020 American Heart Association
Adult Bradycardia Learning Station Checklist

Adult Bradycardia Algorithm

1
Assess appropriateness for clinical condition.
Heart rate typically <50/min if bradyarrhythmia.

2
Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IV access
• 12-Lead ECG if available; don’t delay therapy
• Consider possible hypoxic and toxicologic causes

3 Persistent
bradyarrhythmia causing:
4 No • Hypotension?
Monitor and observe • Acutely altered mental status?
• Signs of shock? Doses/Details
• Ischemic chest discomfort? Atropine IV dose:
• Acute heart failure? First dose: 1 mg bolus.
Repeat every 3-5 minutes.
Yes Maximum: 3 mg.
Dopamine IV infusion:
5
Usual infusion rate is
Atropine
5-20 mcg/kg per minute.
If atropine ineffective: Titrate to patient response;
• Transcutaneous pacing taper slowly.
and/or Epinephrine IV infusion:
• Dopamine infusion
2-10 mcg per minute infusion.
or Titrate to patient response.
• Epinephrine infusion
Causes:
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
6 calcium-channel blockers,
Consider: beta blockers, digoxin)
• Hypoxia
• Expert consultation
• Electrolyte abnormality
• Transvenous pacing (eg, hyperkalemia)
© 2020 American Heart Association
Adult Tachycardia With a Pulse Learning Station Checklist

Adult Tachycardia With a Pulse Algorithm

1
Assess appropriateness for clinical condition. Doses/Details
Heart rate typically ≥150/min if tachyarrhythmia. Synchronized cardioversion:
Refer to your specific device’s recommended energy level to
maximize first shock success.
Adenosine IV dose:
First dose: 6 mg rapid IV push; follow with NS flush.
2 Second dose: 12 mg if required.
Identify and treat underlying cause
Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
• Maintain patent airway; assist breathing as necessary
Procainamide IV dose:
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood 20-50 mg/min until arrhythmia suppressed, hypotension ensues,
pressure and oximetry QRS duration increases >50%, or maximum dose 17 mg/kg given.
• IV access Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
• 12-lead ECG, if available Amiodarone IV dose:
First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.
Sotalol IV dose:
100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.

3 Persistent 4
tachyarrhythmia causing:
Synchronized cardioversion
• Hypotension? Yes
• Acutely altered mental status? • Consider sedation 5
• Signs of shock? • If regular narrow complex, If refractory, consider
• Ischemic chest discomfort? consider adenosine
• Underlying cause
• Acute heart failure?
• Need to increase
energy level for next
No cardioversion
7 • Addition of anti-
6 Yes Consider arrhythmic drug
Wide QRS?
• Adenosine only if • Expert consultation
≥0.12 second
regular and monomorphic
• Antiarrhythmic infusion
No • Expert consultation

8
• Vagal maneuvers (if regular)
• Adenosine (if regular)
• β-Blocker or calcium channel blocker
• Consider expert consultation
© 2020 American Heart Association
Adult Post–Cardiac Arrest Care Learning Station Checklist

Adult Post–Cardiac Arrest Care Algorithm

1
ROSC obtained Initial Stabilization Phase

Resuscitation is ongoing during the

2 post-ROSC phase, and many of these
Manage airway activities can occur concurrently.
Early placement of endotracheal tube However, if prioritization is
necessary, follow these steps:
• Airway management:
Manage respiratory parameters
Waveform capnography or
Initial Start 10 breaths/min
capnometry to confirm and monitor
Stabilization Spo2 92%-98%
endotracheal tube placement
Phase Paco2 35-45 mm Hg
• Manage respiratory parameters:
Titrate Fio2 for Spo2 92%-98%; start
Manage hemodynamic parameters at 10 breaths/min; titrate to Paco2 of
Systolic blood pressure >90 mm Hg 35-45 mm Hg
Mean arterial pressure >65 mm Hg • Manage hemodynamic parameters:
Administer crystalloid and/or
3 vasopressor or inotrope for goal
Obtain 12-lead ECG systolic blood pressure >90 mm Hg
or mean arterial pressure >65 mm Hg

4 Continued Management and

Consider for emergent cardiac intervention if Additional Emergent Activities
• STEMI present
These evaluations should be done
• Unstable cardiogenic shock
concurrently so that decisions on
• Mechanical circulatory support required
targeted temperature management
(TTM) receive high priority as
5 cardiac interventions.
• Emergent cardiac intervention:
Follows commands?
Early evaluation of 12-lead
No Yes electrocardiogram (ECG); consider
Continued hemodynamics for decision on
6 7
Management cardiac intervention
Comatose Awake
and Additional • TTM: If patient is not following
• TTM Other critical care
Emergent commands, start TTM as soon as
• Obtain brain CT management
Activities possible; begin at 32-36°C for 24
• EEG monitoring
• Other critical care hours by using a cooling device with
management feedback loop
• Other critical care management
– Continuously monitor core
temperature (esophageal,
8 rectal, bladder)
Evaluate and treat rapidly reversible etiologies
– Maintain normoxia, normocapnia,
Involve expert consultation for continued management euglycemia
– Provide continuous or intermittent
electroencephalogram (EEG)
monitoring
– Provide lung-protective ventilation

H’s and T’s

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
© 2020 American Heart Association
Adult Cardiac Arrest Learning Station Checklist (VF/pVT/Asystole/PEA)

Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA)

1
CPR Quality
Start CPR
• Give oxygen • Push hard (at least 2 inches
• Attach monitor/defibrillator [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
2 9 compression-ventilation ratio.
VF/pVT Asystole/PEA • Quantitative waveform
capnography
– If Petco2 is low or decreasing,
reassess CPR quality.
3 Shock Epinephrine Shock Energy for Defibrillation
ASAP
• Biphasic: Manufacturer
4 10 recommendation (eg, initial
dose of 120-200 J); if unknown,
CPR 2 min CPR 2 min use maximum available.
• IV/IO access Second and subsequent doses
• IV/IO access
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
capnography • Monophasic: 360 J

Rhythm No Drug Therapy

shockable? • Epinephrine IV/IO dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes • Amiodarone IV/IO dose:
shockable?
First dose: 300 mg bolus.
5 Shock Second dose: 150 mg.
or
No Lidocaine IV/IO dose:
6 First dose: 1-1.5 mg/kg.
CPR 2 min Second dose: 0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
nometry to confirm and monitor
Rhythm No ET tube placement
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths/min) with continu-
Yes ous chest compressions

7 Shock Return of Spontaneous

Circulation (ROSC)

8 • Pulse and blood pressure

11
• Abrupt sustained increase in
CPR 2 min CPR 2 min Petco2 (typically ≥40 mm Hg)
• Amiodarone or lidocaine • Spontaneous arterial pressure
• Treat reversible causes
• Treat reversible causes waves with intra-arterial
monitoring

Reversible Causes
No Rhythm Yes
• Hypovolemia
shockable? • Hypoxia
• Hydrogen ion (acidosis)
12 • Hypo-/hyperkalemia
• Hypothermia
• If no signs of return of Go to 5 or 7 • Tension pneumothorax
spontaneous circulation • Tamponade, cardiac
(ROSC), go to 10 or 11 • Toxins
• If ROSC, go to • Thrombosis, pulmonary
• Thrombosis, coronary
Post–Cardiac Arrest Care
• Consider appropriateness
of continued resuscitation
© 2020 American Heart Association
Cardiac Arrest in Pregnancy In-Hospital ACLS Learning Station Checklist

Cardiac Arrest in Pregnancy In-Hospital ACLS Algorithm Maternal Cardiac Arrest

• Team planning should be

1 done in collaboration with the
Continue BLS/ACLS
obstetric, neonatal, emergency,
• High-quality CPR anesthesiology, intensive care,
• Defibrillationwhenindicated and cardiac arrest services.
• OtherACLSinterventions • Priorities for pregnant women
(eg, epinephrine) in cardiac arrest should include
provision of high-quality
CPR and relief of aortocaval
2 compression with lateral
Assemble maternal cardiac arrest team uterine displacement.
• The goal of perimortem
cesarean delivery is to improve
3 maternal and fetal outcomes.
Consider etiology
of arrest • Ideally, perform perimortem
cesarean delivery in 5 minutes,
depending on provider
4 6 resources and skill sets.
Perform maternal interventions Perform obstetric
interventions Advanced Airway
• Perform airway management
• Administer100%O2, avoid • Provide continuous lateral
• In pregnancy, a difficult airway
excess ventilation uterine displacement is common. Use the most
• Place IV above diaphragm • Detachfetalmonitors experienced provider.
• If receiving IV magnesium, stop and • Prepare for perimortem • Provide endotracheal
give calcium chloride or gluconate cesarean delivery intubation or supraglottic
advanced airway.
• Perform waveform
5 7 capnography or capnometry
Continue BLS/ACLS Perform perimortem to confirm and monitor ET tube
• High-quality CPR cesarean delivery placement.
• Defibrillationwhenindicated • IfnoROSCin5minutes, • Once advanced airway is in
• OtherACLSinterventions consider immediate place, give 1 breath every
(eg, epinephrine) perimortem cesarean delivery 6 seconds (10 breaths/min)
with continuous chest
compressions.
8
Neonatal team to Potential Etiology of Maternal
receive neonate Cardiac Arrest

A Anestheticcomplications
B Bleeding
C Cardiovascular
D Drugs
E Embolic
F Fever
G Generalnonobstetriccauses
of cardiac arrest (H’s and T’s)
H Hypertension
©2020AmericanHeartAssociation
Adult Ventricular Assist Device Learning Station Checklist

Adult Ventricular Assist Device Algorithm

Assist ventilation if necessary

and assess perfusion
• Normal skin color and temperature?
• Normal capillary refill?

Assess and treat Yes No Assess LVAD function

non-LVAD causes for altered Adequate perfusion? • Look/listen for alarms
mental status, such as • Listen for LVAD hum
• Hypoxia
• Blood glucose
• Overdose
• Stroke
Yes
MAP >50 mm Hg and/or
LVAD functioning?
Petco2 >20 mm Hg*?
No
Yes No
Attempt to restart LVAD
• Driveline connected?
• Power source connected?
• Need to replace system
controller?

Do not perform Perform No

external chest external chest LVAD restarted?
compressions compressions

Yes

Follow local EMS

and ACLS protocols

Notify VAD center

and/or medical control *The Petco2 cutoff of >20 mm Hg should be used only when an ET tube or tracheostomy
and transport is used to ventilate the patient. Use of a supraglottic (eg, King) airway results in a falsely
elevated Petco2 value.

© 2020 American Heart Association

Megacode Practice Learning Station Checklist: Case 48
Tachycardia → VF → Asystole → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes unstable tachycardia
Recognizes symptoms due to respiratory arrest (choking)
VF Management
Recognizes VF
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
Asystole Management
Recognizes asystole
Verbalizes potential reversible causes of asystole (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 49/52/57/60/62
Tachycardia → VF → PEA → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes unstable tachycardia
Performs immediate synchronized cardioversion
VF Management
Recognizes VF
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
PEA Management
Recognizes PEA
Verbalizes potential reversible causes of PEA (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 50
Bradycardia → Pulseless VT → Asystole → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes symptomatic bradycardia
Administers correct dose of atropine
Prepares for second-line treatment
Pulseless VT Management
Recognizes pVT
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
Asystole Management
Recognizes asystole
Verbalizes potential reversible causes of asystole (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 51/54
Bradycardia → Pulseless VT → PEA → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes symptomatic bradycardia
Administers correct dose of atropine
Prepares for second-line treatment
Pulseless VT Management
Recognizes pVT
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
PEA Management
Recognizes PEA
Verbalizes potential reversible causes of PEA (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 53
Tachycardia → VF → Asystole → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes unstable tachycardia
Recognizes symptoms due to tachycardia
Performs immediate synchronized cardioversion
VF Management
Recognizes VF
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
Asystole Management
Recognizes asystole
Verbalizes potential reversible causes of asystole (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 55/58
Tachycardia → Pulseless VT → PEA → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes unstable tachycardia
Recognizes symptoms due to tachycardia
Performs immediate synchronized cardioversion
Pulseless VT Management
Recognizes pulseless VT
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
PEA Management
Recognizes PEA
Verbalizes potential reversible causes of PEA (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 56/59
Bradycardia → VF → Asystole → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes symptomatic bradycardia
Administers correct dose of atropine
Prepares for second-line treatment
VF Management
Recognizes VF
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
Asystole Management
Recognizes asystole
Verbalizes potential reversible causes of asystole (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association
Megacode Practice Learning Station Checklist: Case 61
Tachycardia → VF → PEA → PCAC
Student Name __________________________________________ Date of Test ___________________

Check
Critical Performance Steps if done
correctly

Team Leader
Assigns team member roles
Ensures high- Compression rate Compression Chest compression Chest recoil Ventilation
quality CPR at 100-120/min depth of ≥2 inches fraction >80% (optional) (optional)
all times ☐ ☐ ☐ ☐ ☐
Ensures that team members communicate well
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV
Places monitor leads in proper position
Recognizes unstable tachycardia
Recognizes symptoms due to gunshot wound
VF Management
Recognizes VF
Clears before analyze and shock
Immediately resumes CPR after shocks
Appropriate airway management
Appropriate cycles of drug–rhythm check/shock–CPR
Administers appropriate drug(s) and doses
PEA Management
Recognizes PEA
Verbalizes potential reversible causes of PEA (H’s and T’s)
Administers appropriate drug(s) and doses
Immediately resumes CPR after rhythm and pulse checks
Post–Cardiac Arrest Care
Identifies ROSC
Ensures BP and 12-lead ECG are performed, O2 saturation is monitored, verbalizes need for
endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management
STOP TEST
Test Results  Circle PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials _________ Instructor Number ___________________________ Date ____________________
Learning Station Competency
☐ Bradycardia ☐ Tachycardia ☐ Cardiac Arrest/Post–Cardiac Arrest Care ☐ Megacode Practice
© 2020 American Heart Association