Algorithm-Opioid-HC_Provider

Algorithm-BLS_Ped_Single_Rescuer
Algorithm-BLS_Ped_2_Rescuers
Algorithm-BLS_in_Pregnancy
Algorithm-BLS_Adult
Adult Basic Life Support Algorithm for Healthcare Providers
Text in cascading boxes describes the actions that a provider should perform in sequence during an adult cardiac arrest.
Arrows guide providers from one box to the next as they perform the actions. Some boxes have 2 arrows that lead outward,
each to a different box depending on the outcome of the most recent action taken. Pathways are linked.

Box 1
Verify scene safety.

Box 2
 Check for responsiveness.
 Shout for nearby help.
 Activate the emergency response system via mobile device (if appropriate).
 Get an AED and emergency equipment (or send someone to do so).

Box 3
Look for no breathing or only gasping and check pulse (simultaneously).
Is a pulse definitely felt within 10 seconds?
If the person is breathing normally and has a pulse, proceed to Box 3a.
If the person is not breathing normally but has a pulse, proceed to Box 3b.
If the person is not breathing or is only gasping and no pulse is felt, proceed to Box 4.

Box 3a
Monitor the person until emergency responders arrive.

Box 3b
 Provide rescue breathing, 1 breath every 6 seconds or 10 breaths per minute.
 Check pulse every 2 minutes; if no pulse, start CPR.
 If it is a possible opioid overdose, administer naloxone if available per protocol.

By this time in all scenarios, emergency response system or backup is activated, and AED and emergency equipment are
retrieved or someone is retrieving them.

Box 4
Start CPR
 Perform cycles of 30 compressions and 2 breaths.
 Use the AED as soon as it is available.

Box 5
The AED arrives.

Box 6
The AED checks the rhythm. Is the rhythm shockable?
If Yes, the rhythm is shockable, proceed to Box 7.
If No, the rhythm is nonshockable, proceed to Box 8.

Box 7
 Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by the AED to allow rhythm check).
 Continue until advanced life support providers take over or the victim starts to move.

Box 8
 Resume CPR immediately for 2 minutes (until prompted by the AED to allow rhythm check).
 Continue until advanced life support providers take over or the victim starts to move.
Pediatric Basic Life Support Algorithm for Healthcare Providers—Single Rescuer
Text in cascading boxes describes the actions that a single rescuer should perform in sequence during a pediatric cardiac
arrest. Arrows guide the rescuer from one box to the next as the rescuer performs the actions. Some boxes have 2 arrows that
lead outward, each to a different pathway depending on the outcome of the most recent action taken. Pathways are
hyperlinked.

Box 1
Verify scene safety.

Box 2
 Check for responsiveness.
 Shout for nearby help.
 Activate the emergency response system via mobile device (if appropriate).

Box 3
Look for no breathing or only gasping and check pulse (simultaneously). Is a pulse definitely felt within 10 seconds?
If there is normal breathing and a pulse is felt, proceed to Box 3a.
If there is no normal breathing but a pulse is felt, proceed to Box 3b.
If there is no breathing or there is only gasping and no pulse is felt, proceed to Box 5.

Box 3a
Monitor until emergency responders arrive.

Box 3b
 Provide rescue breathing, 1 breath every 2 to 3 seconds, or about 20 to 30 breaths per minute.
 Assess pulse rate for no more than 10 seconds.
Proceed to Box 4.

Box 4
Is heart rate less than 60 per minute with signs of poor perfusion?
If Yes, proceed to Box 4a.
If No, proceed to Box 4b.

Box 4a
Start CPR.

Box 4b
 Continue rescue breathing: check pulse every 2 minutes.
 If no pulse, start CPR.

Box 5
Was the sudden collapse witnessed?
If Yes, proceed to Box 5a.
If No, proceed to Box 6.

Box 5a
Activate the emergency response system (if not already done) and retrieve the AED or defibrillator, then proceed to Box 6.

Box 6
Start CPR.
 1 rescuer: Perform cycles of 30 compressions and 2 breaths.
 When the second rescuer arrives, perform cycles of 15 compressions and 2 breaths.
 Use the AED as soon as it is available. Proceed to Box 7.

Box 7
After about 2 minutes, if still alone, activate the emergency response system and retrieve AED (if not already done). Proceed
to Box 8.

Box 8
Check rhythm. Is it a shockable rhythm?
If Yes, it is shockable, proceed to Box 9.
If No, it is nonshockable, proceed to Box 10.

Box 9
 Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check).
 Continue until advanced life support providers take over or the child starts to move. Return to Box 8, if necessary.

Box 10
 Resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check).
 Continue until advanced life support providers take over or the child starts to move. Return to Box 8, if necessary.
Pediatric Basic Life Support Algorithm for Healthcare Providers—2 or More Rescuers
Text in cascading boxes describes the actions that 2 or more rescuers should perform in sequence during a pediatric cardiac
arrest. Arrows guide the rescuers from one box to the next as they perform the actions. Some boxes have 2 arrows that lead
outward, each to a different pathway depending on the outcome of the most recent action taken. Pathways are hyperlinked.

Box 1
Verify scene safety.

Box 2
 Check for responsiveness.
 Shout for nearby help.
 First rescuer remains with the child. Second rescuer activates the emergency response system and retrieves the
AED and emergency equipment.

Box 3
Look for no breathing or only gasping and check pulse (simultaneously). Is pulse definitely felt within 10 seconds?
If there is normal breathing and a pulse is felt, proceed to Box 3a.
If there is no normal breathing but a pulse is felt, proceed to Box 3b.
If there is no breathing or there is only gasping and no pulse is felt, proceed to Box 5.

Box 3a
Monitor until emergency responders arrive.

Box 3b
 Provide rescue breathing, 1 breath every 2 to 3 seconds, or about 20 to 30 breaths per minute.
 Assess pulse rate for no more than 10 seconds. Proceed to Box 4.

Box 4
Is heart rate less than 60 per minute with signs of poor perfusion?
If Yes, proceed to Box 4a.
If No, proceed to Box 4b.

Box 4a
Start CPR.

Box 4b
 Continue rescue breathing: check pulse about every 2 minutes.
 If no pulse, start CPR.

Box 5
Start CPR
 First rescuer performs cycles of 30 compressions and 2 breaths.
 When second rescuer returns, perform cycles of 15 compressions and 2 breaths.
 Use the AED as soon as it is available. Proceed to Box 6.

Box 6
Check rhythm. Is it a shockable rhythm?
If Yes, it is shockable, proceed to Box 7.
If No, it is nonshockable, proceed to Box 8.

Box 7
 Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check).
 Continue until advanced life support providers take over or the child starts to move. Return to Box 6, if necessary.

Box 8
 Resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check).
 Continue until advanced life support providers take over or the child starts to move. Return to Box 6, if necessary.
Adult Basic Life Support in Pregnancy Algorithm for Healthcare Providers
Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked.

Box 1
Verify scene safety.

Box 2
 Check for responsiveness.
 Shout for nearby help.
 Activate emergency response system via mobile device (if appropriate).
o –Alert them about maternal cardiac arrest.
 Get AED and emergency equipment (or send someone to do so).

Box 3
Look for no breathing or only gasping and check pulse (simultaneously). Is pulse definitely felt within 10 seconds?
If normal breathing, pulse felt, proceed to Box 3a.
If no normal breathing, pulse felt, proceed to Box 3b.
If no breathing or only gasping, pulse not felt, proceed to Box 4.
By this time in all scenarios, emergency response system or backup is activated, and AED and emergency equipment are
retrieved, or someone is retrieving them.

Box 3a
 Roll/wedge victim onto left side.
 Monitor until emergency responders arrive.

Box 3b
 Provide rescue breathing, 1 breath every 6 seconds or 10 breaths per minute.
 Check pulse every 2 minutes; if no pulse, start CPR.
 If possible opioid overdose, administer naloxone if available per protocol.

Box 4
Start CPR
 Perform cycles of 30 compressions and 2 breaths.
 Use AED as soon as it is available.

Box 5
If uterus is at or above the umbilicus and additional rescuers are present, perform continuous lateral uterine
displacement.

Box 6
 AED arrives.

Box 7
Check rhythm. Shockable rhythm?
If yes, shockable, proceed to Box 8.
If no, nonshockable, proceed to Box 9.

Box 8
 Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check).
 Continue until ALS providers take over or victim starts to move.
Proceed to Box 7.

Box 9
 Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check).
 Continue until ALS providers take over or victim starts to move.
Proceed to Box 7.
Sidebar: Maternal Cardiac Arrest
Priorities for pregnant women in cardiac arrest include
 Continuation of high-quality CPR with attention to good ventilation
 Lateral uterine displacement to relieve pressure on major vessels in the abdomen to help with blood flow
 Rapid initiation of emergency medical services to direct care and early transport to the appropriate facility
 ACLS
Adult Cardiac Arrest Algorithm, emphasis on VT/pVT
Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked. This algorithm emphasizes Boxes 1 through 8. Boxes 9 through 12 are emphasized in a different version of this
algorithm, even though they are included here.

Box 1
Start CPR
 Give oxygen
 Attach monitor/defibrillator
Rhythm shockable?
Yes, proceed to Box 2 for VF/pVT.

Box 2
VF/pVT

Box 3
Deliver shock.

Box 4
CPR 2 minutes
 IV/IO access
Rhythm shockable?
If Yes, proceed to Box 5.
If No, proceed to Box 12.

Box 5
Deliver shock.

Box 6
CPR 2 minutes
Epinephrine every 3 to 5 minutes.
Consider advanced airway, capnography.
Is rhythm shockable?
If Yes, proceed to Box 7.
If No, proceed to Box 12.

Box 7
Deliver shock.

Box 8
CPR 2 minutes
 Amiodarone or lidocaine.
 Treat reversible causes.

Box 9
Asystole/PEA.
Give Epinephrine ASAP.

Box 10
CPR 2 minutes
IV/IO access.
Epinephrine every 3 to 5 minutes.
Consider advanced airway, capnography.
Is rhythm shockable?
If Yes, proceed to Box 5 or Box 7.
If No, proceed to Box 11.

Box 11
CPR 2 minutes.
 Treat reversible causes.
Is rhythm shockable?
If Yes, proceed to Box 5 or Box 7.
If No, proceed to Box 12.

Box 12
 If no signs of return of spontaneous circulation (ROSC), go to Box 10 or Box 11
 If ROSC, go to Post–Cardiac Arrest Care
 Consider appropriateness of continued resuscitation

Sidebar
CPR Quality
 Push hard (at least 5 cm) and fast (100-120/min) and allow complete chest recoil.
 Minimize interruptions in compressions.
 Avoid excessive ventilation.
 Change compressor every 2 minutes, or sooner if fatigued.
 If no advanced airway, 30 to 2 compression-ventilation ratio.
 Quantitative waveform capnography
o –If PETCO  is low or decreasing, reassess CPR quality.
2

Shock Energy for Defibrillation

 Biphasic: Manufacturer recommendation (eg, initial dose of 120-200 Joules); if unknown, use maximum available.
Second and subsequent doses should be equivalent, and higher doses may be considered.
 Monophasic: 360 Joules
Drug Therapy
 Epinephrine IV/IO dose: 1 milligram every 3 to 5 minutes
 Amiodarone IV/IO dose: First dose: 300 milligram bolus. Second dose: 150 milligram.
or
Lidocaine IV/IO dose: First dose: 1-1.5 milligrams per kilogram. Second dose: 0.5-0.75 milligrams per kilogram.
Advanced Airway
 Endotracheal intubation or supraglottic advanced airway
 Waveform capnography or capnometry to confirm and monitor ET tube placement
 Once advanced airway in place, give 1 breath every 6 seconds (10 breaths per minute) with continuous chest
compressions
Return of Spontaneous Circulation (ROSC)
 Pulse and blood pressure
 Abrupt sustained increase in PETCO  (typically greater than or equal to 40 millimeters of mercury)
2

 Spontaneous arterial pressure waves with intra-arterial monitoring

Reversible Causes
 Hypovolemia
 Hypoxia
 Hydrogen ion (acidosis)
 Hypo-/hyperkalemia
 Hypothermia
 Tension pneumothorax
 Tamponade, cardiac
 Toxins
 Thrombosis, pulmonary
 Thrombosis, coronary
Adult Cardiac Arrest Circular Algorithm
Cascading numbered boxes and a circular pattern correspond to actions the provider should perform in sequence.

Box 1
Start CPR
 Give oxygen.
 Attach monitor/defibrillator.

Box 2
 Check rhythm. This box starts a repetitive pattern, represented by the outside of a circle.
If VF/pVT, deliver shock, followed by 2 minutes of:
o –Continuous CPR
o –Monitor CPR Quality
o –Continuous CPR
 After 2 minutes, check rhythm again and repeat this cycle until Return of Spontaneous Circulation (ROSC), then
initiate post-cardiac arrest care.
Inside the circle are listed things to perform as necessary during the resuscitation effort:
Drug Therapy
 IV/IO access
 Epinephrine every 3 to 5 minutes
 Amiodarone or lidocaine for refractory VF/pVT
Consider Advanced Airway
 Quantitative waveform capnography
Treat Reversible Causes

Sidebar
CPR Quality
 Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow complete chest recoil.
 Minimize interruptions in compressions.
 Avoid excessive ventilation.
 Change compressor every 2 minutes, or sooner if fatigued.
 If no advanced airway, 30 to 2 compression-ventilation ratio.
 Quantitative waveform capnography
o –If PETCO  is low or decreasing, reassess CPR quality.
2

Shock Energy for Defibrillation

 Biphasic: Manufacturer recommendation (eg, initial dose of 120 to 200 Joules); if unknown, use maximum
available. Second and subsequent doses should be equivalent, and higher doses may be considered.
 Monophasic: 360 Joules
Drug Therapy
 Epinephrine IV/IO dose: 1 milligram every 3 to 5 minutes
 Amiodarone IV/IO dose: First dose: 300 milligram bolus. Second dose: 150 milligrams.
or
Lidocaine IV/IO dose: First dose: 1-1.5 milligrams per kilogram. Second dose: 0.5-0.75 milligrams per kilogram.
Advanced Airway
 Endotracheal intubation or supraglottic advanced airway
 Waveform capnography or capnometry to confirm and monitor
ET tube placement
 Once advanced airway in place, give 1 breath every 6 seconds (10 breaths per minute) with continuous chest
compressions
Return of Spontaneous Circulation (ROSC)
 Pulse and blood pressure
 Abrupt sustained increase in PETCO  (typically greater than or equal to 40 millimeters of mercury)
2

 Spontaneous arterial pressure waves with intra-arterial monitoring

Reversible Causes
 Hypovolemia
 Hypoxia
 Hydrogen ion (acidosis)
  Hypo-/hyperkalemia
 Hypothermia
 Tension pneumothorax
 Tamponade, cardiac
 Toxins
 Thrombosis, pulmonary
 Thrombosis, coronary

Adult Cardiac Arrest Algorithm, emphasis on Asystole/PEA

Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked. This algorithm emphasizes Boxes 9 through 12. Boxes 1 through 8 are emphasized in a different version of this
algorithm, even though they are included here.

Box 1
Start CPR
 Give oxygen
 Attach monitor/defibrillator
Rhythm shockable?
No, proceed to Box 9 for Asystole/PEA.

Box 2
VF/pVT

Box 3
Deliver shock.

Box 4
CPR 2 minutes
 IV/IO access
Rhythm shockable?
If Yes, proceed to Box 5.
If No, proceed to Box 12.

Box 5
Deliver shock.

Box 6
CPR 2 minutes
Epinephrine every 3 to 5 minutes.
Consider advanced airway, capnography.
Is rhythm shockable?
If Yes, proceed to Box 7.
If No, proceed to Box 12.

Box 7
Deliver shock.

Box 8
CPR 2 minutes
 Amiodarone or lidocaine.
 Treat reversible causes.

Box 9
Asystole/PEA.
Give Epinephrine ASAP.

Box 10
CPR 2 minutes
 IV/IO access.
 Epinephrine every 3 to 5 minutes.
 Consider advanced airway, capnography.
Is rhythm shockable?
If Yes, proceed to Box 5 or Box 7.
If No, proceed to Box 11.

Box 11
CPR 2 minutes.
  Treat reversible causes.
Is rhythm shockable?
If Yes, proceed to Box 5 or Box 7.
If No, proceed to Box 12.

Box 12
 If no signs of return of spontaneous circulation (ROSC), go to Box 10 or Box 11
 If ROSC, go to Post–Cardiac Arrest Care
 Consider appropriateness of continued resuscitation

Sidebar
CPR Quality
 Push hard (at least 5 cm) and fast (100-120/min) and allow complete chest recoil.
 Minimize interruptions in compressions.
 Avoid excessive ventilation.
 Change compressor every 2 minutes, or sooner if fatigued.
 If no advanced airway, 30 to 2 compression-ventilation ratio.
 Quantitative waveform capnography
o –If PETCO  is low or decreasing, reassess CPR quality.
2

Shock Energy for Defibrillation

 Biphasic: Manufacturer recommendation (eg, initial dose of 120-200 Joules); if unknown, use maximum available.
Second and subsequent doses should be equivalent, and higher doses may be considered.
 Monophasic: 360 Joules
Drug Therapy
 Epinephrine IV/IO dose: 1 milligram every 3 to 5 minutes
 Amiodarone IV/IO dose: First dose: 300 milligram bolus. Second dose: 150 milligram.
or
Lidocaine IV/IO dose: First dose: 1-1.5 milligrams per kilogram. Second dose: 0.5-0.75 milligrams per kilogram.
Advanced Airway
 Endotracheal intubation or supraglottic advanced airway
 Waveform capnography or capnometry to confirm and monitor ET tube placement
 Once advanced airway in place, give 1 breath every 6 seconds (10 breaths per minute) with continuous chest
compressions
Return of Spontaneous Circulation (ROSC)
 Pulse and blood pressure
 Abrupt sustained increase in PETCO  (typically greater than or equal to 40 millimeters of mercury)
2

 Spontaneous arterial pressure waves with intra-arterial monitoring

Reversible Causes
 Hypovolemia
 Hypoxia
 Hydrogen ion (acidosis)
 Hypo-/hyperkalemia
 Hypothermia
 Tension pneumothorax
 Tamponade, cardiac
 Toxins
 Thrombosis, pulmonary
 Thrombosis, coronary
Adult Ventricular Assist Device Algorithm
Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked.

Box 1
Assist ventilation if necessary and assess perfusion
 Normal skin color and temperature?
 Normal capillary refill?

Box 2
Adequate perfusion?
If Yes, proceed to Box 3.
If No, proceed to Box 6.

Box 3
Assess and treat non-LVAD causes for altered mental status, such as
 Hypoxia
 Blood glucose
 Overdose
 Stroke

Box 4
Follow local EMS and ACLS protocols

Box 5
Notify VAD center and/or medical control and transport

Box 6
Assess LVAD function
 Look/listen for alarms
 Listen for LVAD hum

Box 7
LVAD functioning?
If Yes, proceed to Box 8.
If No, proceed to Box 11.

Box 8
Is MAP greater than 50 millimeters of mercury and/or P ETCO  greater than 20 millimeters of mercury? Note: the PETCO  cutoff
2 2

of greater than 20 millimeters of mercury should be used only when an ET tube or tracheostomy is used to ventilate the
patient. Use of a supraglottic (eg, King) airway results in a falsely elevated P ETCO  value.
2

If Yes, proceed to Box 9.

If No, proceed to Box 10.

Box 9
Do not perform external chest compressions. Proceed to Box 4.

Box 10
Perform external chest compressions. Proceed to Box 4.

Box 11
Attempt to restart LVAD
 Driveline connected?
 Power source connected?
 Need to replace system controller?

Box 12
LVAD restarted?
If Yes, proceed to Box 4.
If No, proceed to Box 10.

Cardiac Arrest in Pregnancy In-Hospital ACLS Algorithm

Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked.

Box 1
Continue BLS/ACLS
 High-quality CPR
 Defibrillation when indicated
 Other ACLS interventions (eg, epinephrine)

Box 2
Assemble maternal cardiac arrest team.

Box 3
Consider etiology of arrest
To perform maternal interventions, proceed to Box 4.
To perform obstetric interventions, procced to Box 6.

Box 4
Perform maternal interventions
 Perform airway management
 Administer 100% oxygen, avoid excess ventilation
 Place IV above diaphragm
 If receiving IV magnesium, stop and give calcium chloride or gluconate

Box 5
Continue BLS/ACLS
 High-quality CPR
 Defibrillation when indicated
 Other ACLS interventions (eg, epinephrine)

Box 6
Perform obstetric interventions
 Provide continuous lateral uterine displacement
 Detach fetal monitors
 Prepare for perimortem cesarean delivery

Box 7
Perform perimortem cesarean delivery
 If no ROSC in 5 minutes, consider immediate perimortem cesarean delivery

Box 8
Neonatal team to receive neonate

Sidebar
Maternal Cardiac Arrest
 Team planning should be done in collaboration with the obstetric, neonatal, emergency, anesthesiology, intensive
care, and cardiac arrest services.
 Priorities for pregnant women in cardiac arrest should include provision of high-quality CPR and relief of
aortocaval compression with lateral uterine displacement.
 The goal of perimortem cesarean delivery is to improve maternal and fetal outcomes.
 Ideally, perform perimortem cesarean delivery in 5 minutes, depending on provider resources and skill sets.
Advanced Airway
 In pregnancy, a difficult airway is common. Use the most experienced provider.
 Provide endotracheal intubation or supraglottic advanced airway.
 Perform waveform capnography or capnometry to confirm and monitor ET tube placement.
 Once advanced airway is in place, give 1 breath every 6 seconds (10 breaths per minute) with continuous chest
compressions.
Potential Etiology of Maternal Cardiac Arrest
A = Anesthetic complications
B = Bleeding
C = Cardiovascular
D = Drugs
E = Embolic
F = Fever
G = General nonobstetric causes of cardiac arrest (H’s and T’s)
H = Hypertension

Adult Post–Cardiac Arrest Care Algorithm

Cascading numbered boxes correspond to actions the provider should perform in sequence. Each box is separated by an
arrow that signifies the pathway the provider should take. Some boxes are separated by 2 arrows that lead to different boxes,
meaning that the provider should take a different pathway depending on the outcome of the previous action. Pathways are
hyperlinked. Boxes 1 through 3 show the Initial Stabilization Phase. Boxes 4 through 8 show Continued Management and
Additional Emergent Activities.

Box 1
ROSC obtained

Box 2
Manage airway
Early placement of endotracheal tube
then
Manage respiratory parameters
Start 10 breaths per minute
SPO  92% to 98%
2

PaCO  35 to 45 millimeters of mercury

2

then
Manage hemodynamic parameters
Systolic blood pressure greater than 90 millimeters of mercury
Mean arterial pressure greater than 65 millimeters of mercury

Box 3
Obtain 12-lead ECG

Box 4
Consider for emergent cardiac intervention if
 STEMI present
 Unstable cardiogenic shock
 Mechanical circulatory support required

Box 5
Follows commands?
If Yes, proceed to Box 7.
If No, proceed to Box 6.

Box 6
Comatose

TTM

Obtain brain CT

EEG monitoring

Other critical care management
Proceed to Box 8.

Box 7
Awake
Other critical care management
Proceed to Box 8.

Box 8
Evaluate and treat rapidly reversible etiologies
Involve expert consultation for continued management

Sidebar
Initial Stabilization Phase
Resuscitation is ongoing during the post-ROSC phase, and many of these activities can occur concurrently. However, if
prioritization is necessary, follow these steps:
 Airway management:
Waveform capnography or capnometry to confirm and monitor endotracheal tube placement
 Manage respiratory parameters:
 Titrate FIO  for Spo  92% to 98%; start at 10 breaths per minute; titrate to Pa CO  of 35 to 45 millimeters of mercury
2 2 2

 Manage hemodynamic parameters:

Administer crystalloid and/or vasopressor or inotrope for goal systolic blood pressure greater than 90 millimeters
of mercury or mean arterial pressure greater than 65 millimeters of mercury
Continued Management and Additional Emergent Activities
These evaluations should be done concurrently so that decisions on targeted temperature management (TTM) receive high
priority as cardiac interventions.
 Emergent cardiac intervention:
Early evaluation of 12-lead electrocardiogram (ECG); consider hemodynamics for decision on cardiac intervention
 TTM: If patient is not following commands, start TTM as soon as possible; begin at 32 to 36 degrees Celsius for
24 hours by using a cooling device with feedback loop
 Other critical care management
o –Continuously monitor core temperature (esophageal, rectal, bladder)
o –Maintain normoxia, normocapnia, euglycemia
o –Provide continuous or intermittent electroencephalogram (EEG) monitoring
o –Provide lung-protective ventilation
H’s and T’s
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary