ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

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1 ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 Copyright 2010 American Heart Association

2 ACLS Cardiac Arrest Circular Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

3 Bradycardia Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

4 Tachycardia Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

5 Post-cardiac arrest care algorithm Peberdy, M. A. et al. Circulation 2010;122:S768-S786

6 Acute Coronary Syndromes Algorithm O'Connor, R. E. et al. Circulation 2010;122:S787-S817

7 Goals for management of patients with suspected stroke Jauch, E. C. et al. Circulation 2010;122:S818-S828

8 Adenosine/ Adenocard Amiodarone ACLS Code Drugs Drug Indications Dosage Administration Narrow PSVT/SVT Wide QRS Tachy of uncertain cardiac origin Vfib/pulseless VT, VT with a pulse. May be used for rate control of WPW or atrial tachycardias. 6 mg followed by 12mg in 1-2 min. 300mg IVP for cardiac arrest. Consider repeating with 150mg in 3-5 min. 150mg over 10 min for stable VT, may repeat 150mg every 10 min as needed. Cumulative dose of 2.2 IV in 24 hrs. Slow infusion 360mg IV over 6 hrs, maintenance 540mg over 18 hrs. (0.5mg/min) Rapid IV push close to the hub followed by a saline bolus. Draw up with filtered needle. Administer drip with filtered tubing. Gtt infusion mixed 900mg/500 D5W. 1mg/min = 33.3cc/hr.5mg/min = 16.6cc/hr Half life is up to 40 days. Atropine Symptomatic sinus bradycardia..5 mg IV every 3-5 min for bradycardia, not to exceed 3 mg Do not give less than 0.5mg IV. Tracheal 2-3mg diluted in 10cc NS. May be given IV, IO, or ET Does not work with heart transplant patients due to denervation. Calcium Chloride Known or suspected hyperkalemia (renal fx). Hypocalcemia after multiple blood tx. Antidote for calcium channel blockers or beta blocker overdose 8-16mg/kg IV for hyperkalemia and calcium channel blocker overdose. Do not mix with sodium bicarbonate. Dopamine Used for hypotension with signs and symptoms of shock or bradycardia Mixed 400mg/250D5W 2-10mcg/kg/min. IV line must be a good one. Will cause extravasation with infiltration Epinephrine Cardiac arrest, VF, pulseless VT, asystole, PEA Symptomatic bradycardia, severe hypotension, anaphylaxis Cardiac arrest: 1mg of the 1:10,000 administered q 3-5 min follow each dose with IV flush. Bradycardia or hypotension use a gtt. Do not mix with sodium bicarbonate. 1mg/250cc: 1mcg/min = 15 cc/hr. May be given IV, IO or ET

9 Drug Indications Dosage Administration Magnesium Sulfate Torsades de pointes or suspected hypomagnesemia. Life threatening arrhythmias due to dig toxicity. 1-2 gm diluted in 10 cc D5W IVP if in cardiac arrest. If not in cardiac arrest mix 1-2 gm in; 50 to 100 cc D5W to infuse over 5 to 60 min. May cause fall in BP with rapid administration. Use with caution if renal failure is present. Morphine Sulfate Used for treatment of ischemic chest pain, acute cardiogenic pulmonary edema, anxiety Dosage should be in 1 to 2 mg increments up to 10 mg max Given slow IV over 1-2 min Precautions: respiratory depression and hypotension Decreases the myocardial preload and causes peripheral venous pooling. Narcan/Naloxone Used to reverse respiratory depression that results from narcotics Also used for coma of unknown etiology Dosage 0.4 mg to 2 mg IV or IO and may be given ET IV or IO meds should be given over 1 min. Precautions: If given rapidly IV/IO can cause projectile vomiting Patient may become agitated or violent Procainamide Sotalol Anti-arrhythmic for stable wide QRS Tachycardia Hemodynamically Stable Monomorphic Ventricular Tachycardia 3 rd Line Anti-Arrhythmic Sodium Bicarbonate Preexisting hyperkalemia, metabolic acidosis, prolonged resuscitation mg/min End Points: Arrhythmia suppressed, hypotension ensues, QRS duration increase >50%, max dose 17 mg/kg 100 mg over 5 min or Avoid if prolonged QT 1.5 mg/kg over 5 min 1 meq/kg IV bolus. Repeat half dose q 10 min Not recommended for routine use in cardiac arrest patients. Vasopressin May be used as an alternative pressor to epi in the treatment of Cardiac Arrest instead of 1 st or 2 nd dose of epi IV, IO 40 U IV push X 1 dose only. ET 80U X 1 dose only Do not give any epi for 10 min after vosopressin is given. Compiled by: Rebecca Cass, NREMT-P innovative solutions in healthcare education, llc 5923 cherrycrest lane charlotte, nc

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