ACLS

Ventricular tachycardia

rate is usually greater than 180 beats per minute and the rhythm generally has a very wide QRS complex.http://acls-

Ventricular fibrillation

Ventricular fibrillation

Ventricular fibrillation is always pulseless and must be confirmed by EKG or defibrillator monitor. Defibrillation is the treatment of choice and should occur as soon as possible.

PEA is treated by assessing and correcting the underlying cause. These causes can be summed up in the 6 H’s and 6 T’s of ACLS. Use the link to review the H’s and T’s.

• Hypovolemia, hypoxia, H-ions, 
• Hypo/hyperkolemia, hypoglycemia, hypothermia

Hypovolemia and hypoxia 

Asystole or “flatline”

If asystole is visualized on the monitor, you should ensure that all leads are connected properly. If all leads are properly connected, you should rapidly assess for any underlying causes for the asystole.

First-Degree Heart Block

Second-Degree Heart Block (Type 1)

Second-Degree (AV) Heart Block (Type 2)

Supraventricular Tachycardia (SVT)

Classic Paroxysmal SVT has a narrow QRS complex & has a very regular rhythm. Inverted P waves are sometimes seen after the QRS complex. These are called retrograde p waves

Unstable patients with SVT and a pulse are always treated with cardioversion

Atrial Flutter

Monomorphic Ventricular Tachycardia

Normal ETCO2 in the adult patient should be 35-45 mmHg.

High quality chest compressions are achieved when the ETCO2 value is at least 10-20 mmHg.

• (1) Check responsiveness
• (2) Active emergency response system and obtain a AED
• (3) Circulation: Check for a carotid pulse. This pulse check should not take more than 5-10 seconds.
• (4) Defibrillation:

epinephrine and vasopressin.1 milligram of epinephrine is given IV or IO every 3-5 minutes. 40 Units of vasopressin can be given IV or IO to replace the first or second dose of epinephrine.

Atropine: The first drug of choice for symptomatic bradycardia. Dose in the Bradycardia ACLS algorithm is 0.5mg IV push and may repeat up to a total dose of 3mg.Dopamine:

Dopamine:-line drug for symptomatic bradycardia when atropine is not effective. Dosage is 2-10 micrograms/kg/min infusion.

Epinephrine: Can be used as an equal alternative to dopamine when atropine is not effective. Dosage is 2-10 micrograms/min.

For the patient with symptomatic bradycardia with signs of poor perfusion, transcutaneous pacing is the treatment of choice.

1 breath every 5 to 6 seconds

1 breath should be given every 6-8 seconds (8-10 breaths per minute).

• 1.  Maintain oxygen saturation >94%
• 2.  Treat hypotension <90 mmHG 
• 3.  Follow commands; yes: coronary perfusion 
•                                        No: Hypothermia

10-12 breaths/min; PETCo2 35-45mm HG 

1-2 Liter bolus

• Epinephrine 0.1-0.5 mcg/kg/min 
• Norepinephrine  0.1-0.5 mcg/kg/min
• Dopamine  5-10mcg/kg/min

Magnesium 1-2 gm IV over 5-10mins in D5W

Amiodorone 300mg IV first dose 

Amiodorone 150mg IV 2nd dose in 3-5 minutes

10 seconds

• Increase efforts in CPR if .....
• PETCO2  value <10mm Hg 
• Arterial relaxation pressure is <20mm hg 
• SVO2 is <30%

• 1-1.5 mg/kg IV or IO 
• repeat dose of 0.5-0.75mg/kg 

max dose of 3mg/kg

32-34 degrees for 12-24 hrs

Right ventricular MI, due to nitroglycerin decrease to preload.

• Systolic pressure <90mm Hg
• HR <60,  or tachycardia

Use of sildenafil or vardenafil