ACLS (Main)

The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.

See critical care quick reference for drug doses and equipment size by weight. This page is for adult patients. For pediatric patients, see: PALS (Main).

Background

  • A series of clinical algorithms created by the AHA/ASA used in the treatment of cardiovascular/neurological emergencies.
  • Involves airway management, IV access, and ECG interpretation.

ECG Analysis

  • What is the atrial and ventricular rate?
  • Is the rhythm regular or irregular?
    • If irregular, does it follow any repeatable pattern?
  • What is the axis?
    • ERAD often seen in VT but not SVT
  • What is the P wave amplitude, duration, morphology, and synchrony with QRS complex?
    • Is the P wave positive in Lead II
  • What is the QRS complex amplitude, duration, morphology?
  • What is the T wave amplitude, duration, morphology?
    • Is the T wave positive in Lead II
  • What is the length of PR and QT intervals?
  • Is there ST Elevation/Depression or Hyperacute T waves?
    • If yes, does it follow any anatomical pattern or is it diffuse?
  • Is there anything else abnormal about this ECG?
    • Pacemaker Spikes
    • Hypertrophy of atrial/ventricles

Algorithms

Treatable Conditions

Condition Common clinical settings Corrective actions
Acidosis
Cardiac tamponade
Hypothermia
  • If severe (temperature <30°C), limit initial shocks for V-Fib or pulseless V-Tach to three; initiate active internal rewarming and cardiopulmonary support. Hold further resuscitation medications or shocks until core temperature is >30°C.
  • If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas
Hypovolemia, hemorrhage, anemia
Hypoxia
  • Consider in all patients with cardiac arrest
  • Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
Hypomagnesemia
Myocardial infarction
  • Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass)
Poisoning
  • Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote
  • Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available
Hyperkalemia
  • If hyperkalemia is identified or strongly suspected, treat with all of the following: 10% calcium chloride (5-10 mL by slow intravenous push; do not use if hyperkalemia is secondary to digitalis poisoning), glucose and insulin (50 mL of 50% dextrose in water and 10 units of regular insulin intravenously), sodium bicarbonate (50 mmoL intravenously; most effective if concomitant metabolic acidosis is present), and albuterol (15-20mg nebulized or 0.5mg by intravenous infusion)
Hypokalemia
  • If profound hypokalemia (<2-2.5 mmoL of potassium per liter) is accompanied by cardiac arrest, initiate urgent intravenous replacement (2 mmoL/min intravenously for 10-15 mmoL), then reassess
Pulmonary embolism
  • Hospitalized patient, recent surgical procedure, peripartum, known risk factors for venous thromboembolism, history of venous thromboembolism, or prearrest presentation consistent with diagnosis of acute pulmonary embolism
  • Administer fluids; augment with vasopressors as necessary
  • Confirm diagnosis, if possible; consider immediate cardiopulmonary bypass to maintain patient's viability
  • Consider definitive care (eg, thrombolytic therapy, embolectomy by interventional radiology or surgery)
Tension pneumothorax

See Also

External Links

References