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Advanced Cardiac Life Support
Advanced Cardiac Life Support
Assess Responsiveness
Unresponsive
Call for code team and Defibrillator
Assess breathing (open the airway, look,
listen and feel for breathing)
If Not Breathing,
give two slow breaths.
Assess Circulation
PULSE NO PULSE
Initiate CPR
Give oxygen by bag mask
Secure IV access If witnessed arrest, give
Determine probable etiology of arrest precordial thump and
based on history, physical exam, cardiac check pulse. If absent,
monitor, vital signs, and 12 lead ECG. continue CPR
Ventricular
fibrillation/tachycardia
(VT/VF) present on
Hypotension/shock, monitor?
acute pulmonary
edema.
Go to fig 8 NO YES
Intubate VT/VF
Confirm tube placement Go to Fig 2
Determine rhythm and
Arrhythmia cause.
YES NO
Continue CPR
Defibrillate 360 J, 30-60 seconds after each dose of medication
Repeat amiodarone (Cordarone) 150 mg IVP prn (if reurrent VF/VT) ,up to max
cumulative dose of 2200 mg in 24 hours
Continue CPR. Administer sodium bicarbonate 1 mEq/kg IVP if long arrest period
Repeat pattern of drug-shock, drug-shock
Fig 4 - Asystole
BRADYCARDIA
No Yes
Type II second degree AV heart If type II second or 3rd degree heart block,
block or third degree AV heart wide complex escape beats, MI/ischemia,
block? denervated heart (transplant),new bundle
branch block: Initiate Pacing(transcutanous
or venous)
No or borderline
Fig 6 Tachycardia
Adenosine 12 mg, rapid IV Lidocaine
push over 1-3 seconds (may 1-1.5 mg/kg IV push. Magnesium 2-4 gm IV
repeat once in 1-2 min); max Repeat over 5-10 min
total 30 mg mg/kg IVP q5-10min
to max total 3 mg/kg
Complex Overdrive
(cutaneous or venous)
Isoproterenol 2-20 mcg/min
Narrow Wide OR
Phenytoin 15 mg/kg IV at 50
Blood Pressure ? If mg/min OR
syndrome, Lidocaine 1.0-1.5 mg/kg IVP
(Cordarone) 150-300 mg IV Cardioversion 200 J
Normal or elevated pressure Low-unstable over 10-20 min
Procainamide
Verapamil mg/min IV to max
2.5-5 mg IV Procainamide total 17 mg/kg
20-30 mg/min, max total 17 mg/kg;
15-30 min followed by 2-4 mg/min
If WPW, avoid adenosine, beta-
Verapamil blockers,
5-10 mg IV digoxin
Synchronized cardioversion
Atrial flutter 50 J
PSVT 50 J
Atrial fibrillation 100 J
Monomorphic V-tach 100 J
Polymorphic V tach 200 J