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| == Recommendations ==
| | ''See [[critical care quick reference]] for drug doses and equipment size by weight. |
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| *Routine use of cricoid pressure is NOT recommended
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| *Airway adjunct is recommended while performing ventilation
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| *Pulse/rhythm checks should only occur q2min
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| *Most critical component is high-quality compressions
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| *Atropine and cardiac pacing are NOT recommended for asystole/PEA
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| == BLS ==
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| *Compressions
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| **Push hard (2cm) and fast (100pm)
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| **Do everything possible to minimize compression interruption
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| *Ventilation
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| **30:2 ratio when do not have advanced airway
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| ***Do not overventilate! (leads to decr venous return)
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| **8-10 breaths per min when intubated
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| == ECG Analysis ==
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| | ==ECG Analysis== |
| #Is the rhythm fast or slow? | | #Is the rhythm fast or slow? |
| #Are the QRS complexes wide or narrow? | | #Are the QRS complexes wide or narrow? |
| #Is the rhythm regular or irregular? | | #Is the rhythm regular or irregular? |
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| == Ventricular fibrillation and pulseless ventricular tachycardia == | | ==Algorithms== |
| | | *[[Adult Pulseless Arrest]] |
| *Shock as quickly as possible | | *[[ACLS: Bradycardia]] (with pulse) |
| **Resume CPR immediately after shocking | | **Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA |
| **Biphasic - 200J
| | *[[ACLS: Tachycardia]] |
| **Monophasic - 360 J
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| *Give Epi 1mg if shock + 2min of CPR fails to convert the rhythm
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| *Consider aniarrhytmic if 2nd shock + 2min CPR again fails
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| **Amiodarone 300mg w/ repeat dose of 150mg as indicated
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| **Magnesium 2g IV, followed by maintenance infusion
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| ***Only for polymorphic Vtach
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| == Asystole and PEA ==
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| *Give Epi 1mg q3-5min
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| *Consider H's and T's
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| **Hypovolemia
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| **Hypoxia
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| **Hydrogen ion
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| **Hypo/hyperkalemia
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| **Hypothermia
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| **Tension pneumo
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| **Tamponade
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| **Toxins
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| **Thrombosis, pulmonary
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| **Thrombosis, coronary
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| == Bradycardia ==
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| *Only intervene if pt is symptomatic
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| **Hypotension, AMS, chest pain, pulm edema
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| *1st Line
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| *Transcutaneous pacing
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| *Chronotropes
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| **Dopamine 2-10mcg/kg/min
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| **Epineprhine 2-10mcg/min
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| *2nd Line
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| **Atropine 0.5mg q3-5m can be given as temporizing measure
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| ***Do not give if Mobitz type II or 3rd degree block is present
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| *TransQ pacing and chronotropes ineffective = need for transvenous pacing
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| == Tachycardia ==
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| 3 questions
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| #Is the pt in a sinus rhythm?
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| #Is the QRS wide or narrow?
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| #Is the rhythm regular or irregular?
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| ===Narrow Regular===
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| *1. Sinus Tachycardia
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| **Treat underlying cause
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| *2. SVT
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| **Vagal maneuvers (convert up to 25%)
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| **Adenosine 6mg IVP (can follow with 12mg if initially fails) | |
| ***If adenosine fails initiate rate control with CCB or BB
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| ****Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
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| ****Metoprolol 5mg IVP x 3 followed by 50mg PO
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| ===Narrow Irregular ===
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| *1. MAT | |
| **Treat underlying cause (hypoK, hypomag)
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| *2. Sinus Tachycardia w/ frequent PACs
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| *3. A Fib / A Flutter w/ variable conduction
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| **Rate control with:
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| ***Dilt
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| ***MTP (good in setting of ACS)
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| ***Amiodarone (good in setting of hypotension, CHF)
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| ***Digoxin (good in setting of CHF)
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| ===Wide Regular===
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| *1. V-Tach (until proven otherwise!)
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| *If stable:
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| **Antiarrhytmics
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| ***Procainamide 20mg/min
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| ****Cont until rhythm suppressed, hypotensive, or max dose (17mg/kg)
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| ****Avoid if prolonged QT
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| ***Amiodarone 150mg over 10min, repeated as needed
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| ***Sotalol 100mg IV over 5min
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| ****Avoid if prolonged QT
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| **Elective synchronized cardioversion (100J)
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| **Adenosine may be used for diagnosis and treatment only if:
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| ***Rhythm is regular and monomorphic
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| *2. SVT w/ aberrancy
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| ===Wide Irregular===
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| *DO NOT use AV nodal blockers!
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| **Can precipitate V-Fib
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| *1. A fib w/ preexcitation
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| **1st line - electric cardioversion
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| **2nd line - Procainamide, amiodarone, or sotalol
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| *2. A fib w/ aberrancy
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| *3. Polymorphic V-Tach / Torsades
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| **Emergent defibrillation (NOT synchronized)
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| **Correct electrolyte abnormalities
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| ***HypoK, hypoMag
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| **Stop prolonged QT meds
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| ==See Also== | | ==See Also== |
| | *[[AHA ACLS Recommendation Changes by Year]] |
| | *[[ACLS (Treatable Conditions)]] |
| | *[[BLS (Main)]] |
| | *[[Critical care quick reference]] |
| | *[[Post cardiac arrest]] |
| | *[[PALS (Main)]] |
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| [[ACLS (Treatable Conditions)]]
| | ==References== |
| | | <references/> |
| == Source == | |
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| *AHA 2010 Guidelines for ACLS
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| <br/><br/>
| | ==External Links== |
| | *[http://www.blog.numose.com/emed-basics/pulseless Numose EMed: The Pulseless Patient] |
| | *[http://www.blog.numose.com/emed-cardiology/bradycardia Numose EMed: ACLS Bradycardia] |
| | *[http://www.blog.numose.com/emed-cardiology/svt Numose EMed: ACLS Narrow Complex Tachycardia] |
| | *[http://www.blog.numose.com/emed-cardiology/wct Numose EMed: ACLS Wide Complex Tachycardia] |
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| [[Category:Airway/Resus]] <br/> | | [[Category:Cardiology]] |
| | [[Category:EMS]] |
| | [[Category:Critical Care]] |
