ACLS Code.txt

• Obtain 12-lead ECG
• consider expert consultation
• Attempt vagal maneuvers
• Adenosine 6 mg rapid IV push
• If no conversion, give up to two more doses at 12 mg each

• Obtain 12-lead ECG
• Consider expert consultation
• Control rate with Diltiazem or β-blockers.

• Obtain 12-lead ECG
• Consider expert consultation
• Convert rhythm using Amiodarone – 150 mg over 10 minutes
• Elective cardioversion.

• Obtain 12-lead ECG
• Consider expert consultation
• Consider antiarrhythmics
• If Torsades de pointes, give Magnesium Sulfate – 1 to 2 g over 5-60 minutes.

• CPR – start immediately. Push hard and push fast.
• Shock – analyze rhythm, and shock if in VF/pulseless VT.
• CPR – resume CPR immediately (5 cycles / 2" )
• Epi 1 mg q 3-5 min. Give as soon as possible after resuming CPR
• Shock – analyze rhythm, and shock if in VF/pulseless VT.
• CPR – Continue for 5 cycles / 2 minutes.
• Lidocaine 1-1.5 mg/kg up to 3 mg/kg.
• Shock – analyze rhythm, and shock if in VF/pulseless VT.
• CPR – resume CPR immediately after shock delivery. Continue for 5 cycles / 2 minutes.

Minimize interruptions to chest compressions – do not check a pulse or evaluate the heartrhythm after a shock. After each shock, resume CPR immediately and continue for 5 cycles prior torhythm analysis and possible pulse check. After a second dose of Epinephrine, a second antiarrhythmic dose (Amiodarone 150 mg or Lidocaine 0.5 – 0.75 mg/kg) may given after the next rhythm check.

• Possible causes (consider the 6 H’s and 5 T’s).
• Epinephrine 1 mg q 3-5 min (can replace 1st or 2nd dose of Epi with 40 units Vasopressin).
• Atropine, 1mg IV/IO q 3-5 min to max 3mg (only if electrical rate is < 60)

In PEA, the electrical system of the heart is functioning, but there is a problem with the pump,pipes, or volume – a mechanical part of the system is not working. You can use the 6 H’s and 5 T’s toremember the most common reversible causes of PEA:

• Hypovolemia
• Hypoxia
• Hypo-/Hyperkalemia
• Hypoglycemia
• Hydrogen Ion (acidosis)
• Hypothermia

• Tamponade, cardiac
• Toxins
• Tension Pneumothorax
• Trauma
• Thrombosis (coronary or pulmonary)

• Determine whether to initiate resuscitation.
• Epinephrine 1 mg q 3-5 min
• Atropine, 1mg IV/IO q 3-5 min to max 3mg
• Differential Diagnosis or Discontinue resuscitation – Are they still dead?

Consider the 6 H’s and 5 T’s (see above) – check blood glucose; check core temperature; consider Naloxone; etc.

Synchronized cardioversion is the preferred treatment for unstable patients with a tachycardia such as Atrial Fibrillation, V-Tach with a pulse, or Supraventricular Tachycardia (SVT). The shock is timed by the monitor to be delivered in coordination with the QRS complex of the heart. If the patient is conscious, consider sedation prior to cardioversion; however, synchronized cardioversion should not be delayed while waiting for sedation in severely symptomatic patients.

With a biphasic monitor, dosage and steps are device-dependent; if optimal doses are unknown, begin at 100 J and step up from there.


(With a monophasic monitor, the initial shock is delivered at 100 J; if the rhythm does not terminate, deliver additional shocks in stepwise fashion (200J, 300J, and 360J for subsequent shocks).

External cardiac pacing is the recommended treatment for symptomatic bradycardias. If the patient is conscious, consider sedation; however, pacing should not be delayed while waiting for sedation. Begin pacing at zero milliamps, slowly increasing until capture is achieved. Then, set the rate at 20 beats per minute above the monitored heart rate, with a minimum rate of 50 bpm.

• Rhythm: regular
• Rate: 60-80
• P Waves: (normal)
• PR Interval: (normal) .12-.20
• QRS: (normal) .12 (or less)

• Rhythm: Regular
• Rate: 100-160
• P Waves: (normal)
• PR Interval: (normal) .12-.20
• QRS: (normal) .12 (or less)

• Rhythm: Regular (Runs may be irregular)
• Rate: 150-250
• P Waves: often pointed, hidden in preceding T wave
• PR Interval:
• QRS: (normal) .12 (or less)
• 

• Rhythm: irregular
• P Rate: 350+
• QRS Rate: varies
• P Waves: no
• PR Interval: none
• QRS: (normal) .12 (or less)

• Rhythm: regular or irregular
• P Rate: 250-400
• QRS Rate: varies
• P Waves: V-shaped, Sawtooth, flutter (F-waves)
• PR Interval: no
• QRS: (normal) .12 (or less)

• Rhythm: regular
• Rate: 40-60
• P Waves: (normal)
• PR Interval: (normal)
• QRS: (normal) .12 (or less)

• Rhythm: regular
• Rate: 40-60
• P Waves: usually inverted, may be before, after, or hidden in QRS
• PR Interval: .10 or less
• QRS: (normal) .12 (or less)

• Rhythm: regular
• Rate: ~
• P Waves: normal
• PR Interval: prolonged, > .20, constant
• QRS: (normal) .12 (or less)

• Rhythm: regular (may be irregularly regular)
• Rate: V rate less than A rate
• P Waves: Normal, 1:1, until dropped
• PR Interval: progressively lengthens until dropped
• QRS: (normal) .12 (or less)
• 

• Rhythm: irregular (can be irregularly regular)
• Rate: V rate < A rate
• P Waves: Normal, but some not followed by QRS
• PR Interval: Normal or prolonged, but constant
• QRS: Normal or wide
• 

• Rhythm: A & V are regular, but disassociated
• A Rate: 60-100
• V Rate: 20-40
• P Waves: usually normal, but no relation to QRS
• PR Interval: n/a
• QRS: Can be normal, but usually > .12

• Rhythm:
• Rate:
• P Waves:
• PR Interval:
• QRS:

• Rhythm:
• Rate:
• P Waves:
• PR Interval:
• QRS:

• Rhythm:
• Rate:
• P Waves:
• PR Interval:
• QRS:

• Rhythm: Usually Regular
• Rate: >100 (usually 140-250)
• P Waves: hidden
• PR Interval: n/a
• QRS: >.12 and/or bizzare

• Rhythm: Usually Regular
• Rate: >100 (usually 140-250)
• P Waves: hidden
• PR Interval: n/a
• QRS: >.12 and/or bizzare