Cardiac Arrest (ACLS)

Hard, fast, unrelenting chest compressions are the core of ACLS!!!











Step 1: Check the Patient’s Pulse











* If the patient does not have a pulse, start CPR* Hard, fast, unrelenting compressions* Intubated patients* Continuous Compressions* Non-intubated adults* 30 compressions then 2 breaths… Repeat* Non-intubated pediatrics* 15 compressions then 2 breaths… Repeat











Step 2: Determine if the Rhythm is Shockable or Non-shockable











* Shockable rhythms* Ventricular Fibrillation (VF)* Ventricular Tachycardia (VT)* Non-shockable rhythms* Pulseless electrical activity (PEA)* Asystole











Step 3: Start a Timer For 2 Minutes











* Do a rhythm/pulse check every 2 minutes











Step 4: Is the Patient in a Shockable Rhythm?











* Repeat/coordinate shocks with every 2-minute pulse check* Give 1mg IV/IO epinephrine every 3-5 minutes* Give amiodarone* 300mg with first dose* 150mg with a repeat dose











Step 5: Is the Patient in a Non-Shockable Rhythm?











* Give epinephrine every 4 minutes (every other cycle)











Quick Facts











* Shockable rhythms (VT/VF) have best prognosis* Frequently related to myocardial infarction* Asystole has the worst prognosis* PEA has mixed prognosis (depends on diagnosis)* Two types (wide and narrow)* “Wide” PEA frequently caused by metabolic abnormalities* Consider bicarb and calcium chloride* “Narrow” PEA frequently caused by shock state* Perform bedside ultrasound in attempt to determine cause* “The H’s and T’s”* Hypoxemia* Hypovolemia* Hydrogen Ions* Hyper/hypokalemia* Tension pneumothorax* Tamponade* Toxins* Thrombosis (MI/PE)











Additional Reading











* When to Stop CPR (EM Clerkship)