ACLS Algorhythms

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Ritameeker
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216650
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ACLS Algorhythms
Updated:
2013-11-21 17:14:45
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2010 AHA ACLS Algorhythms Paramedic
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2010 AHA ACLS Algorhythms Paramedic
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  1. Bradycardic Disrhythmias
    (Symptomatic)
    • Sinus Bradycardia
    • 2nd Degree Type I HB
    • 2nd Degree Type II HB
    • 3rd Degree HB
  2. Bradycardic Disrhythmias
    Symptomatic & STABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN
    • 12 Leak EKG
    • IV Access
    • 0.5 mg Atropine: every 3 - 5 minutes, up to max of 3.0 mg
    • Consider:
    •   Epi drip - 2 - 10 mcg/min   OR
    •   Dopamine drip - 2 - 10 mcg/kg/min
    • Consider pacing
    • Expert Consultation
  3. Bradycardic Disrhythmias
    Symptomatic & UNSTABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN: NRB or BVM
    • IV Access
    • 0.5 mg Atropine IV (1 dose only)
    • Place pacing pads on the patient
    • Pace: Turn up energy (60 - 70) until you reach capture, select rate, make sure that you have mechanical & electrical capture.
    • Consider:
    •   Dopamine drip: 2 - 10 mcg/kg/min
    •   OR
    •   Epinephrine drip: 2 - 10 mcg/min
    • Expert Consultation
  4. Tachycardic Disrhythmias
    Narrow & Regular
    • SVT
    • A-Flutter
  5. SVT & A-Flutter
    STABLE
    • BSI
    • Scene Safety
    • Assess ABC's
    • O2 via NRB or BVM
    • 12 Lead EKG
    • IV/IO Access
    • Vagal Maneuvers
    • 6 mg Adenosine: rapid push w/flush
    • Reassess - BP
    • 12 mg Adenosine: rapid push w/flush
    • 0.25 mg/kg Cardizem: IV over 2 minutes
    • 0.35 mg/kg Cardizem: IV over 2 minutes (after 3-5 min)
    • Consider a Beta Blocker (Sotolol 1.5 mg/kg over 5 minutes - avoid if prolonged QT)
    • Expert Consultation
  6. SVT & A-Flutter
    UNSTABLE
    • BSI
    • Scene Safety
    • Assess the ABC's
    • O2 via NRB or BVM
    • IV/IO access
    • Consider sedation
    • Synchronized Cardioversion: 50 - 100 Joules, repeated incrementally
    • Expert Consultation
  7. Tachycardic Dysrhymias
    Narrow & Irregular
    A-Fib
  8. A-Fib
    STABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN
    • 12 Lead EKG
    • IV/IO Access
    • 0.25 mg/kg Cardizem: over 2 minutes
    • 0.35 mg/kg Cardizem: over 2 minutes (3-5 minutes after first dose)
    • Consider Synchronized Cardioversion (120J - 200J)
    • Expert Consultation
  9. A-Fib
    UNSTABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN: NRB or BVM
    • Cardioversion: 120 - 200 Joules
    • Expert Consultation
  10. Tachycardic Disrhythmias
    Wide Complex Tachycardia
    V-Tach with a pulse
  11. V-Tach with a pulse
    STABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN
    • 12 Lead EKG
    • IV/IO Access
    • 6 mg Adenosine: rapid IV w/flush
    • 12 mg Adenosine: rapid IV w/flush
    • 150 mg Amiodarone: over 10 minutes, diluted in 250 mL D5W wide open)
    • Expert Consultation
  12. V-Tach with a pulse
    UNSTABLE
    • BSI
    • Scene Safety
    • ABC's
    • O2 PRN
    • IV access
    • Cardioversion: 100 Joules
    • Repeat incrementally to 200 Joules or manufacturer's specifications
    • Consider: Amiodarone (150 mg over 10 min)
    •   OR  Procainamide (20-50 mg/min) or
    • Expert Consultation
  13. V-Fib / Pulseless V-Tach
    • BSI
    • Scene Safety

    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Attach monitor and pads
    • *OPA & Ventilate - with BVM @ 15 lpm

    • *Rhythm / Pulse Check
    • SHOCK - 200J monophasic / 120J biphasic
    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Obtain IV/IO access
    • *Prepare 1.0 mg Epinephrine 1:10,000

    • *Rhythm / Pulse Check
    • SHOCK - 300J monophasic / 150J biphasic
    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Administer 1.0 mg Epi  (every 3 - 5 min)
    • *Consider an advanced airway with ETC02
    • *Prepare 300 mg Amiodarone

    • *Rhythm / Pulse Check
    • SHOCK - 300J monophasic / 150J biphasic
    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Administer 300 mg Amiodarone IV/IO bolus (2nd bolus of 150 mg may be given in 3 - 5 min)
    • *Continue administering Epi every 3 - 5 min
    • *Consider reversible causes (H's & T's)
    • *After 20 minutes consider Expert Consultation

    • **Lidocaine may be used if Amiodarone is unavailable:
    • 1.0 - 1.5 mg/kg IV/IO - first dose
    • 0.5 - 0.75 mg/kg IV/IO - second dose (5-10 min after 1st dose)
  14. Asystole / PEA
    • BSI
    • Scene Safety

    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Attach monitor & pads
    • *OPA & Ventilate with BVM @ 15 lpm

    • *Rhythm / Pulse Check
    • CPR: 2 min/30:2/At least 2 inches/Full recoil
    • *Obtain IV/IO access
    • *Prepare 1.0 mg Epinephrine (1:10,000)

    • *Rhythm / Pulse Check
    • CPR: switch compressors, monitor quality
    • *Administer 1.0 mg Epinephrine
    • *Readminister Epi every 3 - 5 min
    • *Consider an advanced airway with ETC02
    • *Consider reversible causes (H's & T's)
    • *After 20 min, consider Expert Consultation
  15. Return of Spontanious Circulation
    ROSC
    • *Assess ABC
    • *Maintain Sp02 94% - 99%
    • *Advanced airway & ETC02
    • *IV/IO access - 2 large bore
    • *Fluid bolus - 1 - 2 liters
    • *Vasopressor infusion:
    •      Dopamine 5 - 10 mcg/kg/min
    •      Epinephrine 0.1 - 0.5 mc/kg/min
    • *12 Lead EKG
    • *Consider reversible causes:
    •      Hypovolemia
    •      Hypoxia
    •      Hydrogen ion (acidosis)
    •      Hypo/Hyperthermia
    •      Hypo/Hyperkalemia
    •      Tension Pneumothorax
    •      Tamponade - cardiac
    •      Toxins
    •      Thrombus - P.E.
    •      Thrombus - Coronary
    • Spontaneous Movement / Commands?
    • If no: consider Induced Hypothermia
  16. H's & T's

    H
    • Hypovolemia - Fluid infusion
    •      *Narrow-complex, rapid rate
    •      *Flat neck veins

    • Hypoxia - Oxygen/Ventilation/Intubation
    •      *Slow HR
    •      *Cyanosis
    •      *Airway problems

    • Hydrogen Ion (acidosis) - Ventilation /
    • Sodium Bicarb (1 mEq/kg IV/IO)
    •      *Small QRS complexes
    •      *Hx of Diabetes
    •      *Renal failure

    • Hyperkalemia - Calcium Chloride / Sodium Bicarb / Glucose & Insulin / Albuterol
    •      *Tall, peaked T waves / small P waves
    •      *QRS widens
    •      *Hx of renal failure
    •      *Hx of Diabetes / recent dialysis

    • HypoKalemia - Magnesium Sulfate
    •      *Flattened T waves / Prominent U waves
    •      *QRS widens / QT prolongs
    •      *Wide-complex Tachy
    •      *Diuretic usage
    •      *Abnormal loss of potassium

    • Hypothermia - Warm / Treat for Shock
    •      *J or Osborne waves
    •      *Hx of exposure to cold
  17. H's & T's

    T
    • Tension Pneumo - Needle Decompression
    •      *Narrow complex & Slow Rate
    •      *Hx of pneumo
    •      *No pulse felt during CPR
    •      *JVD and/or Tracheal deviation
    •      *Unequal breath sounds
    •      *Dificult to ventilate

    • Tamaponade (Cardiac) - Pericardiocentesis
    •      *Narrow complex & Rapid Rate
    •      *Hx of tamponade
    •      *JVD
    •      *No pulse felt during CPR

    • Toxins - Intubation / Specific antidotes
    •      *Bradycardias / Pupils
    •      *Various effects

    • Thrombus (Lungs - PE) - Fibrinolytics / Surgery
    •      *Narrow complex & Rapid Rate
    •      *Hx of thrombus, PE, or DVT

    • Thrombus (Heart - MI)
    •      *Abnormal 12-lead
    •      *Good pulse during CPR

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