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ACLS Pocket Card
ACLS Pocket Card
ardiac Arrest Circular Algorithm • Rotate compressor every First dose: 300 mg bolus.
2 minutes Second dose: 150 mg .
• If no advanced airway, 30:2
Advanced Airway
Shout for Help/Activate Emergency Response compression-ventilation ratio
• Supraglottic advanced airway
• Quantitative waveform
or endotracheal intubation
capnography
• Waveform capnography to confirm
Start CPR - If PETC02 <10 mm Hg, attempt
and monitor ET tube placement
o Give oxygen to improve CPR quality
• 8-1 0 breaths per minute with
o Attach monitor/ defibrillator • Intra-arterial pressure
continuous chest compressions
- If relaxation phase (diastolic)
pressure <20 mm Hg, attempt Reversible Causes
2 minutes - Hypovolemia
to improve CPR quality
- Hypoxia
Return of Spontaneous
- Hydrogen ion (acidosis)
Circulation (ROSC)
- Hypo-/ hyperkalemia
• Pulse and blood pressure
- Hypot hermia
• Abrupt sustained increase
- Tension pneumothorax
Drug Therapy in PETC0 2 (typically ;;,40 mm Hg)
- Tamponade, cardiac
IV/10 access • Spontaneous arterial pressure
- Toxins
Epinephrine every 3-5 minutes waves with intra-arterial
- Thrombosis, pu lmonary
A miodarone for refractory VFNT monitoring
- Th rombosis, coronary
Shock Energy No
• Biphasic: Manufacturer
Consider Advanced Airway recommendation (eg, initial
Quantit ative waveform capno grap hy dose of 120-200 J); if unknown , No
use maximum avai lable.
Second and subsequent doses 8 11
should be eqUiva en_, and higher
C PR 2 min
doses may be considered . • Treat reversible causes
• Monopl!_asic: 3.§9 J
12 r-_________ L_ _ _ _ _ __
• If no signs of return of
spontaneous circulation
(ROSC), go to 10 or 11
• If ROSC , go t o
Post-Cardiac Arrest Care Go to 5 or 7
90-1012 (1 of 2) ISBN 978-1-61669-01 3-7 5/11 C 2011 American Heart Association Printed In the USA
mmediate Post-Cardiac Arrest Care Algorithm I Bradycardia With a Pulse Algorithm ! Tachycardia With a Pulse Algorithm
I
I
Assess appropriateness for clinical condition.
Return of Spontaneous Circulation (ROSC) Assess appropriateness for c linical condition.
Heart rate typically ~ 150/min if tachyarrhythmia.
Heart rate typically <50/min if bradyarrhythmia.
Absolute Contraindication&
• Any prior intracranial hemorrhage
Does ECG show STEMI or new or • Known structural cerebral vascular lesion (eg, arteriovenous
presumably new LBBB? malformation)
• Known malignant intracranial neoplasm (primary or metastatic)
• Ischemic stroke within 3 months EXCEPT acute ischemic stroke
within 3 hours
Are there contraindications to fibrinolysis?
Step2 • Suspected aortic dissection
If ANY one of the following is checked YES,
fibrinolysis MAY be contraindicated. • Active bleeding or bleeding diathesis (excluding menses)
• Significant closed head trauma or facial trauma within 3 months
Systolic BP > 180 to 200 mm Hg or diastolic BP > 100 to
110mm Hg ) YES ) NO
) YES ) NO
Relative Contraindication&
Right vs left arm systolic BP difference > 15 mm Hg
History of structural central nervous system disease ) YES ) NO • History of chronic, severe, poorly controlled hypertension
Significant closed head/facial trauma within the
previous 3 weeks ) YES ) NO
• Severe uncontrolled hypertension on presentation
Stroke >3 hours or <3 months ) YES ) NO (SSP > 180 mm Hg or DBP > 11 0 mm Hg)t
Rebent (within 2-4 weeks) major trauma, surgery • History of prior ischemic stroke >3 months, dementia, or known
(including laser eye surgery), GI/GU bleed ) YES ) NO intracranial pathology not covered in contraindications
Any history of intracranial hemorrhage ) YES ) NO
Bleeding, clotting problem, or blood thinners ) YES "J NO • Traumatic or prolonged (> 10 minutes) CPR or major surgery
Pregnant female ) YES :> NO (<3 weeks)
Serious systemic disease (eg, advanced cancer, • Recent (within 2 to 4 weeks) internal bleeding
severe liver or kidney disease) ) YES ) NO
• Noncompressible vascular punctures
Is patient at high risk?
• For streptokinase/anistreplase: prior exposure (>5 days ago) or
Step3 If ANY one of the following is checked YES, prior allergic reaction to these agents
consider transfer to PCI facility.
• Pregnancy
Heart rate ~ 1 00/min AND systolic BP <1 00 mm Hg .) YES ) NO • Active peptic ulcer
Pulmonary edema (rales) ) YES .) NO
) YES ) NO • Current use of anticoagulants: the higher the INA, the higher the
Signs of shock (cool, clammy)
Contraindications to fibrinolytic therapy J vest ) NO risk of bleeding
Required CPR ) YES ) NO
'Contra1ndications for fibrinolytiC use 1n STEM I cons1stent w1th "ThrombolytiC Therapy and Balloon 'Viewed as advisory for clinical decision making and may not be all-inclusive or definitive.
Angioplasty 1n Acute ST Elevation Myocard1allnfarction (STEMI)" at Agency for Healthcare Research
tCould be an absolute contraindication in low-risk patients with myocardial infarction.
and Quality National Gu1dehne Clearinghouse (www.Guidel1nes.gov).
tCons1der transport to pnmary PCI fac1hty as destination hosprtal.
Suspected Stroke Algorithm:
Goals for Management of Stroke
I Stroke Assessment I
10
•
Immediate general assessment and stabilization
• Assess ABCs, v1tal stgns • Perform neurologic screenirtg
as well as the other side
mm
• Prov1de oxygen 1f hypoxemic assessment
• Obtam IV access and perform • Activate stroke team
laboratory assessments • Order emergent CT or MAl of bram
ED • Check glucose: treat if indiCated • Obtaln 12-lead ECG
•
60 min
f Candidate ~