MD Nexus

Advanced Cardiac Life Support (ACLS, 2015 Guidelines)

Cardiac Arrest Algorithm

ACLS

Bradycardia

Tachycardia (HR >150 with Associated Pulse)

Narrow-Complex

Regular (SVT, A-Flutter)

  • Stable
    • Carotid Massage
    • If Regular
      • Adenosine (see Adenosine, [[Adenosine]]): 6 mg -> 12 mg via peripheral IV
        • Use initial dose 50% less if given via central venous catheter, heart transplant, tegretol, dipyridamole
    • Beta Blockers (see β-Adrenergic Receptor Antagonists, [[β-Adrenergic Receptor Antagonists]])
      • Metoprolol (see Metoprolol, [[Metoprolol]]): 5 mg IV
    • Calcium Channel Blockers (see Calcium Channel Blockers, [[Calcium Channel Blockers]])
      • Diltiazem (see Diltiazem, [[Diltiazem]]): 5 mg IV
  • Unstable
    • Consider Adenosine (see Adenosine, [[Adenosine]]): 6 mg -> 12 mg via peripheral IV
      • Use initial dose 50% less if given via central venous catheter, heart transplant, tegretol, dipyridamole
    • Synchronized Cardioversion: Biphasic 50-100 J

Irregular (AF, MAT, Occasionally A-Flutter)

Wide-Complex

Regular (VT, SVT with Aberrancy)

  • Stable (VT, SVT with Aberrancy)
    • Only If Regular + Monomorphic: Adenosine (see Adenosine, [[Adenosine]]) 6 mg -> 12 mg via peripheral IV
      • Use initial dose 50% less if given via central venous catheter, heart transplant, tegretol, dipyridamole
    • Amiodarone (see Amiodarone, [[Amiodarone]]): 150 mg Over 10 min (max: 2.2 g/24 hrs) -> Drip 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs
  • Unstable (Usually VT)
    • Synchronized Cardioversion: 100 J

Irregular (AF with Aberrrancy, AF with WPW, Torsade)

  • Stable
    • If Known AF with Aberrancy
      • Metoprolol (see Metoprolol, [[Metoprolol]]): 5 mg IV
      • Diltiazem (see Diltiazem, [[Diltiazem]]): 5 mg IV
    • If Torsades: Magnesium Sulfate (MgSO4) (see Magnesium Sulfate, [[Magnesium Sulfate]]): 1-2 IV over 1-2 min
    • If Unknown or AF with WPW: Amiodarone (see Amiodarone, [[Amiodarone]]) 150 mg over 10 min (max: 2.2 g/24 hrs) -> Drip 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs
      • Avoid AV nodal blocking agents with irregular wide-complex tachycardia of unknown etiology (ie: possible WPW), as these can cause paradoxical increase in HR or degeneration to VF in WPW
  • Unstable
    • Defbrillate: 200 J
    • If Torsades: Magnesium Sulfate (MgSO4) (see Magnesium Sulfate, [[Magnesium Sulfate]]): 1-2 IV over 1-2 min

Multifocal Atrial Tachycardia (MAT) (see Multifocal Atrial Tachycardia, [[Multifocal Atrial Tachycardia]])

Cardiopulmonary Resuscitation (CPR) Quality

Known/Suspected Opiate Intoxication (see Opiates, [[Opiates]])

Prognostic Factors During CPR

Extra-Corporeal Membrane Oxygenation (ECMO)/Percutaneous Cardiopulmonary Support (CPS) (see Percutaneous Cardiopulmonary Support, [[Percutaneous Cardiopulmonary Support]])

Use of Vasopressors During Cardiac Arrest

Endotracheal Drug Administration (Via ETT) During Cardiac Arrest

Endotracheal Intubation During Cardiac Arrest

Timing of Intubation During CPR

Advantages of Intubation During CPR

Disadvantages of Intubation During CPR

Confirmation of Endotracheal Tube (ETT) Placement During CPR

References