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0% found this document useful (0 votes)
115 views8 pagesACLS Algorithms 2020
Uploaded by
Alaa OmarCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
/ 8
7
Adult Cardiac Arrest
Algorithm
CMe
Tac
American
Heart
Association.
+ Iwnoaceess
CPR2 min
+ Epinephrine every 3-5 min
+ Consider advanced airway,
ceapnography
CPR2min
+ Amiodarone oF lidocaine
@
+ Ino signs of return of (
Start CPR
Gwveoxygen
Asystole/PEA |
1
Epinephrine
‘ASAP
‘CPR2 min
+ WwnOaccess
+ Epinephrine every 3-5:min
Consider advancedairway,
CPR2 min
+ Treatreversible causes:
spontaneous circulation
(OSC), goto 10 or 1
ROSE, goto
Post-Catdae Arrest Care
+ Consider appropriateness
20-1110 (14) 1SBN97B-1-61669-776- 10720,
‘of continued resuscitation
Poshhoealtleast2inches
[Semin tet (100-120!)
andaliow compete chestrecol
+ Mima rtertionsin
Compressions
+ Rrodescessve vatlation
+ Ghangecompressoreveny |
2rmnates, orsooneratques. |
+ Mine advanced sway 302
+ Guntatve waveform
capnegrapty
STHBeTCO lon ordecresing,
reassess CPR ual. |
reeommendstion(eg itis |
ote 0120-200 Jeitunkaown, |
‘isemmximom vais.
Secendand subsequent doses
Should be equivalent and higher
Gosas may conecored
+ Monophasie 360)
a
|. jabeeoseamae
| oesraseas
Soweto
Seen
a
+ Endoacheainubatonersi= |
proglatie advanced away
« Waretomeapnogrey oan:
Ertube plocemert
+ Once odvancedarwayinplacs,
‘vet broath every Bcaconct
{tobreatrami wth contr
buschestconpressione
Pena
Cece)
[+ puceandbioodpressure
1 Abroptaustaineaneeaseln
ered, ttypaly 240 mg)
+ Spontanaous ater pressure
woes wth iva-rteral
Reversible Causes
Hypovolemia
Hypowa
Hyaregenion(acosish
| f Hypo-iyperalema
1 hypetnerie
01080r7 || © Fenian pneumomorax
* Tampontecaoe
1 Thrombosis. pumoaary
1 Thrombosis coronary
crore anecnteateion tensa Bp Adult Post-Cardiac
Arrest Care Algorithm
CNet
Continued
Management
‘and Additional
Emergent
Activities
eis
Manage airway
Early placement of endotracheal tube
‘Manage respiratory parameters
‘Start 10 breaths/min
"'$p0,92%-28%
Consider for emergent cardiac intervention if
+ STEMI present
+ Unstable cardiogenic shock
+1™
+ Obtainbrain CT
American
Heart
Resuscitationis ongoing during the
post-ROSC phase, end many ofthese
Activities can occur concurrently.
However. if prioritization is
necessary follow these steps:
+ Airway management:
Waveform capnography or
ceapnometry to confirm and monitor
‘endotracheal tube placement
Manage respiratory parameters:
Turate Fi, for Spo, 92%-98% start
‘at 10 breaths/min; tate to Paco, of
35-45 mmHg
Manage hemodynamic parameters:
Administer crystalloid andor
vasopressor orinatrope for goal
systolic blood pressure >90 mm Hg
ormean arterial pressure >65 mmHg
Penton
cieileuareaciiicd
‘These evaluations should be done
‘concurrently sothat decisions on
targeted temperature management
(TTM) receive high priority as
‘cardiac interventions,
+ Emergent carciac intervention:
Early evaluation of 12-ead
slectrocardiogram (ECG); consider
hemodynamics for decision on
cardiacintervention
+ TIME Ifpatientis not folowing
commands, start TMas soonas
possible: begin at 32-6°C for 24
hours by using cooling device with
feedbackloop
+ Other ertical care management
~ Continuously monitor core
tempersture (esophageal
rectal. bladder) |
~ Maintain normoxia, normocapnia,
euglycemia
= Pravide continuous or intermittent
tlectroencepnalogram EC)
‘monitoring
Provide ut
|
tective ventilation
Hypovolemia |
Hypoxia |
Hydrogenion acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax |
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary | Adult Tachycardia
With a Pulse Algorithm
Picken rad
‘Assess appropriateness for clinical condition.
21 mi
Identify and treat underlying cause
+ Maintain patent airway:assist breathing as necessary
+ Oxygen ifhypoxemic}
+ Cardi
¥
Persistent
tachyarrhythmia caus!
+ Hypotension?
+ Acutely altered mental status?
* Signs of shock?
Ischemic chest discomfort?
+ Acuteheart failure?
20-1110 2014) ‘SON978-1-61659-776-1
‘Synchronized cardioversion
+ Consider sedation
+ Adenosine only
a
American
Heart
Association.
Doses/Details
‘Synchronized cardioversion:
Refer to your specific device's recommended energy level to
‘maximize first shock success.
‘Adenosine IV dose:
First dose: 6 mg rapid IV push follow with NS flush.
Second dose: 12 mgifrequired.
“Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
Procainamide V dose:
20-50 mgimin unt arrhythmia suppressed, hypotension ensues,
‘GRS duration increases >50%, or maximum dose 17 mg/kg given.
Maintenance infusion: 1-4 mgimin, Avoid prolonged GT or CHF.
‘Amiodarone IV dose:
First dose: 160 mg aver 10 minutes. Repeat as neededif VT recurs,
Follow by maintenance infusion of 1 mg/min for first hours.
| Sotalottv dost
| 100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.
refractory, consider
"= Underiying cause
+ Needtoincrease:
Consider
rand
B
120 ©2020AmericonHeart Assocation PrintedintheUSA Adult Bradycardia
Algorithm
(eM ie eae tad
;ppropriatenes
( Assessay
Identity and treat underlying cause
+ Maintain patent airway; assist breathing as necessary
+ Oxygen ifhypoxemic
a sentfy rhythm: monitor blood,
Persistent
bradyarrhythmia causin
Hypotension?
‘Acutely sltered mental status?
Signs of shock?
Ischemic chest discomfort?
‘Acute heart failure?
Atropine
atropine ineffective:
‘= Transcutaneous pacing
a
‘American
Heart
Association. —
| Atropine IV dost
| First dose: 1 mg bolus.
Repeat every 35 minutes.
Maximum: mo,
Dopamine IV infusion: |
UUsualinfusion rates
5-20 moglkg per minute.
Titrate to patient response;
taper stowly.
Epinephrine IV infusion:
2-10meg per minute infusion.
Titrate to patientresponse.
Causes:
‘= Myocardial ischemia
infarction
+ Drugsitoxicologic (oa
ccalcium-channal blockers, |
beta blockers, digoxin)
| + Hypoxia
Electrolyte abnormality
(es, hyperkalemia)
‘©2020AmercanHoart Association Acute Coronary American
Heart
Syndromes Algorithm Association.
even kee
eee ts aad
EMS assessment and care and hospital preparation
+ Assess ABCs. Be preparedto provide CPRand defbilation
‘Administer aepicin and consider oxygen. ntogyeeri nc morphine needed
ECG. ST levats
Concurrent ED/eathiab assessment Immediate ED/eathiab general treatment
{eto minutes) 170, sat 00% tartonygent man trate
: speeenoe zien | + gn insane oven)
1 Assess Aa: gweoxyoen needed
ECG interpretation
|
STelevationornewor | (( Non-ST-elevation ACS (NSTE-ACS)
presumably new LBEE: Determine iskusing validated
‘strongly suspicious foriniury ‘score le TIMior GRACE)
‘ST-elevation MI(STEM) ‘ eo
(ST depression or dynamic T-vave (NormaiEeGornonclagnostic
| ‘version, transient ST elevation, changes in ST segment or T wave
strongly suspicious forischemia Towesisk core
‘andlor high-risk scare | Low-fintormodiate-risk NSTE-ACS
| Mignerisk wsTE-acs oe
es ‘Troponin elevated or high-risk patont Consider admission to
a os Consider early invasive strategy it: EDchest painunitorto
xs Refractoryischemic chest discomfort appropritebed for
Recurrentpersistont ST deviation
Ventricular tachycardia
Homodynamicinstabilty
s12hours | Adult Suspected Stroke American
Heart
Algorithm Association, —
Eten ke
eee ae ras
tity signs and symptoms of possible stroke
Critical EMS assessments and actions
+ Assess ABCS; give oxygenifneeded
+ Initiate stroke protocol
+ Perform physicalexam
SENSO ea aenumnenataithal
ED orbrain maging suite"
ral and neurologic sssessment by hospital stroke team
‘Activate svoks tam upon EMSnoiicaton
rapa for emergent CT scan or MB bran upon aria
1 Stoktaa mest on rv Cardiac Arrest in Pregnancy American
Heart
In-Hospital ACLS Algorithm Association.
EXT eee as
‘Continue BLS/ACLS
+ High-quality CPR
+ Deribilation when indicated
ora
“+ Team planning should be done in
‘allaboration with tha obstetric,
neonatal emergency,
“anesthesiology, intensive care,
‘nd cardiac arrest services.
+ Priorities for pregnant women
Ineardiac arrest shouldinetude
rovision ofhigh-cuality CPR and
Felt of aortocaval compression with
Iateral uterine cisplacament
+ The goal of perimortem cesarean