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ACLS Algorithm Guide

The document provides a concise guide for Advanced Cardiac Life Support (ACLS) algorithms, emphasizing the importance of following institutional standards. It outlines various emergency scenarios such as respiratory arrest, acute myocardial infarction, and different types of arrhythmias, detailing the necessary steps and pharmacologic interventions. The guide also includes mnemonics to aid in remembering key principles for patient treatment during cardiac emergencies.

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1 views6 pages

ACLS Algorithm Guide

The document provides a concise guide for Advanced Cardiac Life Support (ACLS) algorithms, emphasizing the importance of following institutional standards. It outlines various emergency scenarios such as respiratory arrest, acute myocardial infarction, and different types of arrhythmias, detailing the necessary steps and pharmacologic interventions. The guide also includes mnemonics to aid in remembering key principles for patient treatment during cardiac emergencies.

Uploaded by

tryjohantoro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Advanced Cardiac Life Support

* * 2007 * *
Algorithm Guide
Here is a very abbreviated guide for the ACLS algorithms. Once you understand and can apply
the principles, this guide will help you stay on track. Remember: Patient treatment should be
based upon institutional standards and not according to this guide alone. Approved guidelines are
subject to change.

A few helpful mnemonics:


ABC=Airway, Breathing, Circulation
OMI=Oxygenation, Monitor(EKG), IV
ICEM=IV, CPR, ET intubation, Monitor(EKG)

Respiratory Arrest with a Pulse


 ABC's...call for code cart/equipment, call 911 if outside hospital
 OMI...begin oxygenation, Determine cardiac rythm with Monitor, establish IV
 Look for cause.

Acute Myocardial Infarction


 ABC's...call for code cart/equipment, call 911 if outside hospital
 OMI...begin oxygenization, Determine cardiac rhythm with Monitor, establish IV
 Use appropriate algorithm
 Administer aspirin
 Anyalgesia (consider location if infarct)
 Consider anti-coagulants
 Twelve Lead EKG, labs
 Consider thrombolytics (ST changes, History, Signs/symptoms)
 Consider adjunctive therapy prn.
Refractory VF/ Pulseless VT

 ABC's
 OMI
 ICEM...IV access, CPR, ET intubation, Monitors
 Electrical Intervention... "clear" before each shock)
 Parmacologic intervention
 Consider possible causes such as Acute MI, Hypoxia, Hypoglycemia, Acidosis, etc.
o Electrical defibrillation (X 1)
o 360 joules( monophasic)
o 150-200 joules (biphasic with truncated exponential waveform)
o 120 joules (biphasic with rectiliniar waveform)
o 200 joules (biphasic unknown waveform)
o CPR for 2 minutes, then rhythm check
o Drugs may be administered in conjunction with CPR ! ! !
o Epinephrine 1 mg IV, may repeat every 3-5 minutes
o OR
o Vasopressin 40 units VI single dose only
o Repeat defibrillation if still unsuccessful
o CPR for 2 minutes, then rhythm check
o Amiodarone 300 mg IV bolus
o OR
o Lidocaine about 1- 1.5 mg mg/kg (as 75-100 mg) IV, may repeat 0.5 - 0.75 mg/kg
in 5-10 min (Max: 3 mg/kg); If needed tracheal administration 2-4 mg/kg
o Repeat defibrillation if still unsuccessful
o CPR for 2 minutes, then rhythm check
o May consider Magnesium sulfate 1-2 gm in 10 mL D5W if suspect
hypomagnesemia
o Procainamide 30 mg.min IV infusion (Max: 17 mg/kg)
o Repeat defibrillation if still unsuccessful
o May consider Na bicarbonate 1 ampule IV ? if suspect acidotic (best check ABG
first)
Bradycardia
 ABC's
 OMI
 Consider possible causes such as Acute MI, Hypoxia, Hypoglycemia, Acidosis, etc.
 Parmacologic/Electrical Intervention
 If hemodynamically unstable, CPR for 2 minutes
 Atropine (.5 mg q 5 min...up to 3.0 mg total)
 Transcutaneous Pacing
 Initiate Dopamine drip (2-20 micrograms/kg/min)
 Initiate Epinephrine drip (2-20 micrograms/kg/min)
 If all above fails, Tranvenous Pacing

Second and Third Degree Blocks

 ABC's
 OMI
 Parmacologic/Electrical Intervention
 Consider possible causes such as Acute MI, Hypoxia, Hypoglycemia, Acidosis, etc.
 Transcutaneous Pacing
 Initiate Dopamine drip (2-20 micrograms/kg/min)
 Initiate Epinephrine drip (2-20 micrograms/kg/min)
 If all above fails, Tranvenous Pacing
Unstable Tachycardia
 ABC's
 OMI
 Sedate and Cardiovert
 Valium 2mg. IV increments (to 10 mg. max)
 OR
 Versed 2mg. IV increments (to 10 mg. max)
 VT & A-Fib- start at 100J
 A-Flutter & SVT- start at 50J

Stable Tachycardia
 ABC's
 OMI

Supraventricular Tachycardia (stable)


 ABC's
 OMI
 Vagal Maneuvers- Have patient "Bear-Down", or Carotid Massage)
 Adenosine- 6mg then 12mg (Max 18mg)
 Cardizem- .25 mg/kg/2min, 35mg/kg/2min after 15 min.
 Beta Blockers
 Verapamil- 2.5-5 mg/2 min...5-10 mg after 15 min.
 Digiatlis-(limited use in emergency situations)

Supraventricular Tachycardia (unstable)


 ABC's
 OMI
 Consider meds.
 If meds ineffective sedate and then cardiovert (50-100-200-300-360J)
 Sedate with Valium 2mg. IV increments (to 10 mg. max)
 OR
 Versed 2mg. IV increments (to 10 mg. max)
Atrial Fibrillation/ Flutter- Stable

 ABC's
 OMI
 Pharmacologic Intervention
 Cardizem- .25 mg/kg/2 min, .35 mg/kg/2 min after 15 min.
 Beta Blockers
 Verapamil- 2.5-5 mg/2 min...5-10 mg after 15 min.
 Procainamide- 20 mg/min up to 17mg/kg total.
 Digiatlis-(limited use in emergency situations)

Ventricular Tachycardia- Stable

 ABC's
 OMI
 Pharmacologic Intervention
o In unstable hemodynamically, stat unsynchronized cardioversion with 50 -100
joules, then
o 200, or to 360 joules.
o In stable patients, may use synchronized cardioversion. with 100 J, then 200, 300,
360 J prn
o *** Premedicate with sedatives whenever possible !!! ****
o Amiodarone 150 mg IV bolus over 10 minutes or
o Lidocaine 0.5 - 0.75 mg/kg IV , then 1- 4 mg/min infusion or
o Procainamide 200 1000 mg IV at rate <25 50 mg/min.
o Wide complex tachycardia VT vs SVT of uncertain etiology treat it as VT, & IV
Procainamide is the drug of choice, & ** IV Verapamil is contraindicated !
Pulseless Electrical Activity
 ABC's
 ICEM
 Consider possible causes such as Acute MI, Hypoxia, Hypoglycemia, Acidosis, etc.
 Pharmacologic Intervention
 CPR for 2 minutes
 Epinephrine- 1 mg q 3-5 min or
 Vasopressin- 40 U IV push (single dose)
 CPR for 2 minutes
 Consider termination of efforts after 10 minutes

Asystole

 ABC's
 ICEM confirm rythm in two leads.
 Pharmacologic Intervention
 Consider possible causes such as Acute MI, Hypoxia, Hypoglycemia, Acidosis, etc.
 CPR for 2 minutes
 Epinephrine 1.0 mg IV push, repeat every 3-5 minutes or
 Vasopressin- 40 U IV push (single dose)
 CPR for 2 minutes
 Atropine 1.0 mg IV push

 Consider termination of efforts after 10 minutes.

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